1215240916 NPI number — BURKS MEDICAL CONSULTING

Table of content: (NPI 1215240916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215240916 NPI number — BURKS MEDICAL CONSULTING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURKS MEDICAL CONSULTING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215240916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 REGENCY PKWY
Provider Second Line Business Mailing Address:
413
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76063-3794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-518-9300
Provider Business Mailing Address Fax Number:
817-473-9272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 REGENCY PKWY
Provider Second Line Business Practice Location Address:
413
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76063-3794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-518-9300
Provider Business Practice Location Address Fax Number:
817-473-9272
Provider Enumeration Date:
07/22/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BURKS
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
682-518-9300

Provider Taxonomy Codes

  • Taxonomy code: 246ZE0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)