Provider Demographics
NPI:1750463048
Name:ERNEST G BURCH MD PC
Entity Type:Organization
Organization Name:ERNEST G BURCH MD PC
Other - Org Name:ERNEST G BURCH MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:G
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-633-8881
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE B217
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-633-8881
Mailing Address - Fax:251-633-0467
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE B217
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-633-8881
Practice Address - Fax:251-633-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23467208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10910160OtherCAQH
AL51507815OtherBLUE CROSS
AL009946570Medicaid
AL051507815Medicare PIN
ALG68936Medicare UPIN