1487072674 NPI number — DANIEL L. BURKHEAD, M.D. LTD

Table of content: (NPI 1487072674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487072674 NPI number — DANIEL L. BURKHEAD, M.D. LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL L. BURKHEAD, M.D. LTD
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:
INNOVATIVE PAIN CARE CENTER
Provider Other Organization Name Type Code:
3
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:
1487072674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9920 W. CHEYENNE AVE
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-316-2281
Provider Business Mailing Address Fax Number:
702-316-2272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8955 S. PECOS RD
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-316-2281
Provider Business Practice Location Address Fax Number:
702-316-2272
Provider Enumeration Date:
04/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BURKHEAD
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
702-316-2281

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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