Provider Demographics
NPI:1245491430
Name:BURNHAM & BURNHAM M.D.P.C.
Entity type:Organization
Organization Name:BURNHAM & BURNHAM M.D.P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICIONER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-494-4531
Mailing Address - Street 1:1918 S LEMAY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1294
Mailing Address - Country:US
Mailing Address - Phone:970-494-4531
Mailing Address - Fax:970-494-4538
Practice Address - Street 1:1918 S LEMAY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1294
Practice Address - Country:US
Practice Address - Phone:970-494-4531
Practice Address - Fax:970-494-4538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21180174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD23898Medicare UPIN
COC364608Medicare PIN