# MEDSUR ONE TELEMEDICINE LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568098937
- **Authorized official:** KATHLEEN MCCOY NURSE PRACTITION (MANAGER)
- **Authorized official phone:** (512) 364-2151

## Contact information

- **Practice address:** 110 EISENHOWER COURT (ADMINISTRATIVE OFFICE LOCATION), 1309 COFFEEN AVE STE 1200 SHERIDAN WY 82801, GEORGETOWN, TX 78633
- **Practice address phone:** (307) 655-1666
- **Practice address fax:** (512) 651-4666
- **Mailing address:** 1309 COFFEEN AVENUE STE 1200, SHERIDAN, WY 82801
- **Mailing address phone:** (307) 655-1666
- **Mailing address fax:** (512) 651-4666

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/18/2020
- **Last updated:** 03/18/2020