MEDICARE: MR. KENNETH W. FERBRACHE P.A.

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	363A00000X	Physician Assistant	147	WY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970004512	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073625406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH W. FERBRACHE P.A.

Provider Business Mailing Address
First Line	:	1115 LANE 12
Second Line	:
City	:	LOVELL
State	:	WY
Zip	:	82431-9537
Country	:	US
Telephone Number	:	307-548-5201
Fax Number	:	307-548-5224

Provider Business Practice Location Address
First Line	:	1115 LANE 12
Second Line	:
City	:	LOVELL
State	:	WY
Zip	:	82431-9537
Country	:	US
Telephone Number	:	307-548-5201
Fax Number	:	307-548-5224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/27/2010

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Directions to “ MR. KENNETH W. FERBRACHE P.A.” Practice Location

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