Provider Demographics
NPI:1124384516
Name:BURROWS, JACK A
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:A
Last Name:BURROWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1212
Mailing Address - Country:US
Mailing Address - Phone:419-565-1888
Mailing Address - Fax:
Practice Address - Street 1:169 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:44904-1212
Practice Address - Country:US
Practice Address - Phone:419-565-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide