Provider Demographics
NPI:1033245410
Name:FIRST MED PA
Entity Type:Organization
Organization Name:FIRST MED PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-865-5300
Mailing Address - Street 1:2323 RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-3956
Mailing Address - Country:US
Mailing Address - Phone:785-865-5300
Mailing Address - Fax:785-865-1399
Practice Address - Street 1:2323 RIDGE CT
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-3956
Practice Address - Country:US
Practice Address - Phone:785-865-5300
Practice Address - Fax:785-865-1399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0421523261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSD05360Medicare ID - Type Unspecified