Healthcare Provider Details

I. General information

NPI: 1063744019
Provider Name (Legal Business Name): RICHARD L. BURKEY, D.P.M., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 FOREST AVE
GREAT BEND KS
67530-3607
US

IV. Provider business mailing address

3509 FOREST AVE
GREAT BEND KS
67530-3607
US

V. Phone/Fax

Practice location:
  • Phone: 620-793-7624
  • Fax: 620-793-5281
Mailing address:
  • Phone: 620-793-7624
  • Fax: 620-793-5281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number213E00001X
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number213E00001X
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number213E00001X
License Number StateKS

VIII. Authorized Official

Name: DR. RICHARD L BURKEY
Title or Position: OWNER
Credential:
Phone: 620-793-7624