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General NPI Number Information
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NPI Number | 1780040121
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Entity Type | Organization
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Legal Business Name | JEREMY BURD M.D., LLC
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 4800 RAINBOW SUITE 200
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City | WESTWOOD
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State | KS
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Zip | 66205-1932
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Country | US
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Telephone | 816-679-8334
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Fax | 816-331-3495
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Provider Business Mailing Address
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Address Line | 4800 RAINBOW SUITE 200
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City | WESTWOOD
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State | KS
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Zip | 66205-1932
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Country | US
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Telephone | 816-679-8334
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Fax | 816-331-3495
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Authorized Official
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Title or Position | BILLING COMPANY, CONTRACTING PERSON
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Name | SHERRYL M MANFORD
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Credential |
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Telephone | 816-331-0676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0426995
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License Number State | KS
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