1740512102 NPI number — BURGE MANAGMENT & MARKETING, LLC

Table of content: (NPI 1740512102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740512102 NPI number — BURGE MANAGMENT & MARKETING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURGE MANAGMENT & MARKETING, LLC
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:
1740512102
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 253
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PURVIS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39475-0253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-794-2121
Provider Business Mailing Address Fax Number:
601-794-2199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
177 SHELBY SPEIGHTS
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
PURVIS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-794-2121
Provider Business Practice Location Address Fax Number:
601-794-2199
Provider Enumeration Date:
02/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BURGE
Authorized Official First Name:
VERON
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
601-543-6575

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  08391/11.1 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com