MEDICARE: CODY JAMES RUBLE FIREFIGHTER/MEDIC

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	50651	KS

General Provider Information

NPI Number	:	1548852163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY JAMES RUBLE FIREFIGHTER/MEDIC

Provider Business Mailing Address
First Line	:	2720 FOREST AVE
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-3825
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 WILLIAMS ST
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-4446
Country	:	US
Telephone Number	:	620-792-4140
Fax Number	:

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

Provider Enumeration Date	:	02/04/2021
Last Update Date	:	02/04/2021

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