MEDICARE: RUNWAY EMERGENCY PHYSICIANS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1063751352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUNWAY EMERGENCY PHYSICIANS LLC

Provider Business Mailing Address
First Line	:	18167 US HIGHWAY 19 N STE 650
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33764-6576
Country	:	US
Telephone Number	:	800-507-8874
Fax Number	:	727-536-2896

Provider Business Practice Location Address
First Line	:	8714 W 13TH ST N
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67212-6221
Country	:	US
Telephone Number	:	316-962-9900
Fax Number	:	727-536-2896

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GREGORY J BYRNE
Credential	:	MD
Telephone Number	:	214-712-2000

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	02/06/2013

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