1780659623 NPI number — MR. STEVEN FOSTER BURKE P.A.-C.

Table of content: MR. STEVEN FOSTER BURKE P.A.-C. (NPI 1780659623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780659623 NPI number — MR. STEVEN FOSTER BURKE P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURKE
Provider First Name:
STEVEN
Provider Middle Name:
FOSTER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
Provider Gender Code:
M

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:
1780659623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2409 SPRING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52737-9302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-768-5858
Provider Business Mailing Address Fax Number:
319-753-2301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2409 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52737-9302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-768-5858
Provider Business Practice Location Address Fax Number:
319-753-2301
Provider Enumeration Date:
02/22/2006

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: 363AM0700X , with the licence number:  001481 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 001481 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0080200 . This is a "MEDICAID GROUP" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 13238 . This is a "MEDICARE PART B GROUP" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 8122859 . This is a "BCBS GROUP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CP8565 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 16D0387805 . This is a "CLIA RIVER DRIVE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 13238 . This is a "BCBS GROUP" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 37512 . This is a "BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 42106072402 . This is a "MEDICAID GROUP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 001481 . This is a "IOWA PA LICENSE NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 16-1801 . This is a "MEDICARE NGS GROUP" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 5100759 . This is a "CSC" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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