1801908108 NPI number — TERRY L BURNS MD

Table of content: TERRY L BURNS MD (NPI 1801908108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801908108 NPI number — TERRY L BURNS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNS
Provider First Name:
TERRY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1801908108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
195 HOSPITAL DRIVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
CHEROKEE VILLAGE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-257-6060
Provider Business Mailing Address Fax Number:
870-257-7664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CHEROKEE VILLAGE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-257-6060
Provider Business Practice Location Address Fax Number:
870-257-7664
Provider Enumeration Date:
08/31/2006

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: 207Q00000X , with the licence number:  C6383 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 101356001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50779 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00690776 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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