1518070341 NPI number — AMY G BURNS MD

Table of content: AMY G BURNS MD (NPI 1518070341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518070341 NPI number — AMY G BURNS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNS
Provider First Name:
AMY
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1518070341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 W 8TH AVE RM L2E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99204-2307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-474-4744
Provider Business Mailing Address Fax Number:
509-474-4746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
624 E FRONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202-2139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-626-9900
Provider Business Practice Location Address Fax Number:
509-474-4746
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  MD00046882 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1518070341 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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