Healthcare Provider Details

I. General information

NPI: 1366680126
Provider Name (Legal Business Name): BURDEN MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E 10TH ST
BAXTER SPRINGS KS
66713-1614
US

IV. Provider business mailing address

445 E 10TH ST
BAXTER SPRINGS KS
66713-1614
US

V. Phone/Fax

Practice location:
  • Phone: 620-856-3469
  • Fax:
Mailing address:
  • Phone: 620-856-3469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TYSON L BURDEN
Title or Position: OWNER/CEO
Credential: MD
Phone: 620-856-3469