Provider Demographics
NPI:1841300605
Name:BURMA, ALYCE C
Entity type:Individual
Prefix:MRS
First Name:ALYCE
Middle Name:C
Last Name:BURMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 W RAMM RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-8700
Mailing Address - Country:US
Mailing Address - Phone:918-341-6123
Mailing Address - Fax:918-341-6123
Practice Address - Street 1:643 W RAMM RD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-8700
Practice Address - Country:US
Practice Address - Phone:918-341-6123
Practice Address - Fax:918-341-6123
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5748920001Medicare NSC