Provider Demographics
NPI:1689792020
Name:LARRY BURNETT & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:LARRY BURNETT & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-766-4615
Mailing Address - Street 1:2911 HOPEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-9777
Mailing Address - Country:US
Mailing Address - Phone:336-766-8680
Mailing Address - Fax:336-712-1512
Practice Address - Street 1:2911 HOPEWOOD LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-9777
Practice Address - Country:US
Practice Address - Phone:336-766-4615
Practice Address - Fax:336-712-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000314484332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies