MEDICARE: RICHARD J BURCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD108310	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1583207	OTHER	MO	UNITED HEALTHCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	415917	OTHER	MO	HEALTHLINK
4	118801	OTHER	MO	BLUE CHOICE
5	118801	OTHER	MO	BLUE SHIELD

General Provider Information

NPI Number	:	1477502631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD J BURCH MD

Provider Business Mailing Address
First Line	:	PO BOX 7687
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65205-7687
Country	:	US
Telephone Number	:	573-882-2259
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 S PROVIDENCE RD
Second Line	:	BLDG E
City	:	COLUMBIA
State	:	MO
Zip	:	65203-3624
Country	:	US
Telephone Number	:	573-882-2511
Fax Number	:	573-884-4515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	12/24/2007

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