1174673891 NPI number — BURKE CENTER

Table of content: (NPI 1174673891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174673891 NPI number — BURKE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURKE CENTER
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:
6
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:
1174673891
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 151608
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUFKIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75915-1608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-631-6149
Provider Business Mailing Address Fax Number:
936-639-5837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 STUBBLEFIELD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DIBOLL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75941-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-829-3517
Provider Business Practice Location Address Fax Number:
936-639-5837
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SINGLETON
Authorized Official First Name:
DORTHEY
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTING CLERK
Authorized Official Telephone Number:
936-631-6149

Provider Taxonomy Codes

  • Taxonomy code: 310500000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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