1336683077 NPI number — BURROWS LOCUM TENENS NP, PLLC

Table of content: (NPI 1336683077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336683077 NPI number — BURROWS LOCUM TENENS NP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURROWS LOCUM TENENS NP, PLLC
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:
1336683077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3303 S. LINDSAY RD, SUTIE 119A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85712-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-787-2555
Provider Business Mailing Address Fax Number:
480-900-2041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3303 S LINDSAY RD STE 119A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85297-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-787-2555
Provider Business Practice Location Address Fax Number:
480-900-2041
Provider Enumeration Date:
12/15/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BURROWS
Authorized Official First Name:
MARGO
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
OWNER/FNP
Authorized Official Telephone Number:
307-421-3694

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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