Provider Demographics
NPI:1235372426
Name:D. SCOTT BURKETT, M.D. (A MEDIAL CORPORATION)
Entity Type:Organization
Organization Name:D. SCOTT BURKETT, M.D. (A MEDIAL CORPORATION)
Other - Org Name:BURKETT HEART CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BURKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-323-2328
Mailing Address - Street 1:513 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6229
Mailing Address - Country:US
Mailing Address - Phone:318-323-2328
Mailing Address - Fax:318-323-2221
Practice Address - Street 1:513 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6229
Practice Address - Country:US
Practice Address - Phone:318-323-2328
Practice Address - Fax:318-323-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.15538R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1469955Medicaid
LA1469955Medicaid
LAH31944Medicare UPIN