Healthcare Provider Details

I. General information

NPI: 1528198710
Provider Name (Legal Business Name): BURNT CHURCH PRIMARY AND URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BURNT CHURCH RD
BLUFFTON SC
29910-6405
US

IV. Provider business mailing address

1 BURNT CHURCH RD
BLUFFTON SC
29910-6405
US

V. Phone/Fax

Practice location:
  • Phone: 843-757-9229
  • Fax: 843-757-2930
Mailing address:
  • Phone: 843-757-9229
  • Fax: 843-757-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL KYLE BURTNETT
Title or Position: SVP OF OUTPATIENT SERVICES TENET
Credential:
Phone: 469-893-2153