MEDICARE: DAVID R. FERRELL, M.D., P.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	207P00000X	Emergency Medicine Physician
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1649795279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID R. FERRELL, M.D., P.C.

Provider Business Mailing Address
First Line	:	1001 CONSOL ENERGY DR
Second Line	:
City	:	CANONSBURG
State	:	PA
Zip	:	15317-6506
Country	:	US
Telephone Number	:	304-225-2500
Fax Number	:	724-743-1133

Provider Business Practice Location Address
First Line	:	6401 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1118
Country	:	US
Telephone Number	:	702-878-0295
Fax Number	:	702-878-0297

Authorized Official
Title or Position	:	DIRECTOR PAYOR CONTRACTING
Name	:	BRETT GALL
Credential	:
Telephone Number	:	304-225-2500

Provider Enumeration Date	:	08/04/2017
Last Update Date	:	02/18/2019

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