MEDICARE: RICHARD A BLUM PA-C

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	363AM0700X	Medical Physician Assistant	71500	NE

General Provider Information

NPI Number	:	1306968292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD A BLUM PA-C

Provider Business Mailing Address
First Line	:	1123 N 10TH ST
Second Line	:
City	:	BEATRICE
State	:	NE
Zip	:	68310-2001
Country	:	US
Telephone Number	:	402-228-4295
Fax Number	:	402-228-3702

Provider Business Practice Location Address
First Line	:	1123 N 10TH ST
Second Line	:
City	:	BEATRICE
State	:	NE
Zip	:	68310-2001
Country	:	US
Telephone Number	:	402-228-4295
Fax Number	:	402-228-3702

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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Directions to “ RICHARD A BLUM PA-C” Practice Location

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