Provider Demographics
NPI:1528198710
Name:BURNT CHURCH PRIMARY AND URGENT CARE, LLC
Entity Type:Organization
Organization Name:BURNT CHURCH PRIMARY AND URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP OF OUTPATIENT SERVICES TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:BURTNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2153
Mailing Address - Street 1:1 BURNT CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6405
Mailing Address - Country:US
Mailing Address - Phone:843-757-9229
Mailing Address - Fax:843-757-2930
Practice Address - Street 1:1 BURNT CHURCH RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6405
Practice Address - Country:US
Practice Address - Phone:843-757-9229
Practice Address - Fax:843-757-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8827Medicare PIN