Healthcare Provider Details

I. General information

NPI: 1396792420
Provider Name (Legal Business Name): BURKE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S MEDFORD DR
LUFKIN TX
75901-6260
US

IV. Provider business mailing address

2001 S MEDFORD DR
LUFKIN TX
75901-6260
US

V. Phone/Fax

Practice location:
  • Phone: 936-633-5650
  • Fax: 936-633-5695
Mailing address:
  • Phone: 936-633-5650
  • Fax: 936-633-5695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberH8939
License Number StateTX

VIII. Authorized Official

Name: MRS. TERI SMITH
Title or Position: REVENUE CYCLE ADMINISTRATOR
Credential:
Phone: 936-633-5651