Provider Demographics
NPI:1801868260
Name:WURM, CHARLES M (PA)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:WURM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1657
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66601-1657
Mailing Address - Country:US
Mailing Address - Phone:785-295-5307
Mailing Address - Fax:785-270-7646
Practice Address - Street 1:600 SW JEWELL AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1607
Practice Address - Country:US
Practice Address - Phone:785-292-5310
Practice Address - Fax:785-295-5370
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500413363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100342090DMedicaid
KS100342090DMedicaid
P00453991Medicare PIN
KSR32063Medicare UPIN