Provider Demographics
NPI:1578866547
Name:BURNS PROFESSIONAL OFFICE
Entity Type:Organization
Organization Name:BURNS PROFESSIONAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-792-4003
Mailing Address - Street 1:4503 TEXAS BLVD
Mailing Address - Street 2:BURNS PROFRESSIONAL OFFICE
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503
Mailing Address - Country:US
Mailing Address - Phone:903-792-4003
Mailing Address - Fax:903-792-2230
Practice Address - Street 1:4503 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3026
Practice Address - Country:US
Practice Address - Phone:903-792-4003
Practice Address - Fax:903-792-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty