Provider Demographics
NPI:1962632752
Name:J.T. BURKE, INC.
Entity Type:Organization
Organization Name:J.T. BURKE, INC.
Other - Org Name:MIRACLE-EAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:505-326-5707
Mailing Address - Street 1:817 W BROADWAY
Mailing Address - Street 2:STE A
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5699
Mailing Address - Country:US
Mailing Address - Phone:505-326-5707
Mailing Address - Fax:505-326-4026
Practice Address - Street 1:817 W BROADWAY
Practice Address - Street 2:STE A
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5699
Practice Address - Country:US
Practice Address - Phone:505-326-5707
Practice Address - Fax:505-326-4026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0696332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment