MEDICARE: FALLING SHADOW EMERGENCY PHYSICIANS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1205207412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALLING SHADOW EMERGENCY PHYSICIANS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 98692
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-8692
Country	:	US
Telephone Number	:
Fax Number	:

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	:	469-401-2386
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	GREGORY J. BYRNE
Credential	:	M.D.
Telephone Number	:	469-401-2386

Provider Enumeration Date	:	10/14/2015
Last Update Date	:	10/14/2015

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