Provider Demographics
NPI:1780040121
Name:JEREMY BURD M.D., LLC
Entity Type:Organization
Organization Name:JEREMY BURD M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COMPANY, CONTRACTING PERSON
Authorized Official - Prefix:
Authorized Official - First Name:SHERRYL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-331-0676
Mailing Address - Street 1:4800 RAINBOW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1932
Mailing Address - Country:US
Mailing Address - Phone:816-679-8334
Mailing Address - Fax:816-331-3495
Practice Address - Street 1:4800 RAINBOW
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-1932
Practice Address - Country:US
Practice Address - Phone:816-679-8334
Practice Address - Fax:816-331-3495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04269952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty