Kolleen Burnett, | |
5409 Avenue O, Fort Madison, IA 52627-9601 | |
(319) 376-2134 | |
(319) 376-2188 |
Full Name | Kolleen Burnett |
---|---|
Gender | Female |
Speciality | Pediatrics |
Location | 5409 Avenue O, Fort Madison, Iowa |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1326131665 | NPI | - | NPPES |
1326131665 | Medicaid | IA | |
036105825 | Medicaid | IL | |
132131665 | Other | IA | WELLMARK BLUE CROSS BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 036-105825 (Illinois) | Secondary |
208000000X | Pediatrics | 4236 (Iowa) | Primary |
Entity Name | Memorial Hospital Association |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1730139031 PECOS PAC ID: 0244134682 Enrollment ID: O20031126000246 |
Mailing Address | Practice Location Address |
---|---|
Kolleen Burnett, 5409 Avenue O, Fort Madison, IA 52627-9601 Ph: (319) 376-2134 | Kolleen Burnett, 5409 Avenue O, Fort Madison, IA 52627-9601 Ph: (319) 376-2134 |
Gregory F Gorski, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 5409 Avenue O, Fort Madison, IA 52627 Phone: 319-376-2134 Fax: 319-376-2188 | |
Curt C. Mcclellan, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 5409 Avenue O, Po Box 174, Fort Madison, IA 52627 Phone: 319-376-2134 Fax: 319-376-2188 | |
Susan E Teggatz, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 5409 Avenue O, Suite 1, Fort Madison, IA 52627 Phone: 319-376-2134 Fax: 319-376-2188 |