Provider Demographics
NPI:1851331334
Name:BURCHFIELD FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:BURCHFIELD FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-236-6911
Mailing Address - Street 1:630 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4247
Mailing Address - Country:US
Mailing Address - Phone:870-236-6911
Mailing Address - Fax:870-236-8129
Practice Address - Street 1:630 W COURT ST
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4247
Practice Address - Country:US
Practice Address - Phone:870-236-6911
Practice Address - Fax:870-236-8129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131636001Medicaid
AR131636001Medicaid
AR5K492C666Medicare ID - Type Unspecified