MEDICARE: FIRST MED PA

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	207Q00000X	Family Medicine Physician	0421523	KS

General Provider Information

NPI Number	:	1356300180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST MED PA

Provider Business Mailing Address
First Line	:	2323 RIDGE CT
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-3956
Country	:	US
Telephone Number	:	785-865-5300
Fax Number	:	785-865-1399

Provider Business Practice Location Address
First Line	:	2323 RIDGE CT
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-3956
Country	:	US
Telephone Number	:	785-865-5300
Fax Number	:	785-865-1399

Authorized Official
Title or Position	:	MEDICAL STAFF DIRECTOR
Name	:	RONALD J BURT
Credential	:	MD
Telephone Number	:	785-865-5300

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	08/22/2020

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Directions to “FIRST MED PA ” Practice Location

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