Provider Demographics
NPI:1164530929
Name:ANNA C BURSON, INC
Entity Type:Organization
Organization Name:ANNA C BURSON, INC
Other - Org Name:CORNERSTONE FAMILY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BURSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-226-9994
Mailing Address - Street 1:720 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-4343
Mailing Address - Country:US
Mailing Address - Phone:580-226-9994
Mailing Address - Fax:580-226-9998
Practice Address - Street 1:720 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-4343
Practice Address - Country:US
Practice Address - Phone:580-226-9994
Practice Address - Fax:580-226-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21475207Q00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK21475OtherOK LICENSE #
OK1437109394OtherINDIVIDUAL NPI #
OK=========OtherTAX ID #
OK=========OtherTAX ID #