Kelly R Burse, MD
Individual provider Active NPI Family Medicine Physician · Columbus, IN
NPI 1063618445 · NPPES record last updated Jun 3, 2015
Key facts
- NPI
- 1063618445
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 01064404 (IN)
- Practice address
- 3201 Middle Dr
Columbus, IN 47203-4427 - Phone
- (812) 372-8281
- Fax
- (812) 372-4525
- NPI assigned
- Jun 22, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01064404 | IN | MD | Family Medicine Physician |
| 01064404A | IN | MD | Family Medicine Physician |
| 11012345 | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Columbus Urgent Care Center | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 11012345 | IN | |
| Family Medicine Physician | 207Q00000X | 01064404A | IN | |
| Family Medicine Physician | 207Q00000X | 01064404 | IN | Yes |
Addresses
Primary practice location
3201 Middle Dr
Columbus, IN 47203-4427
Mailing address
2502 25TH St
Columbus, IN 47201-3728
Phone (812) 372-8883
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200886140 | Medicaid | IN |
Other providers in Columbus, IN
- Autumn Burkman
- Breanna Burkman
- Erica Burnett
- Jessica Burns
- Manjula V Burri
- Baylee Burton
- Chris Burton
- Kaitlyn Burton
- Lyndsay Erin Burton
- Melissa Marie Burton
All providers in Columbus, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.