Healthcare Provider Details

I. General information

NPI: 1659421501
Provider Name (Legal Business Name): BURKE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 06/17/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 S MEDFORD DR
LUFKIN TX
75901-5633
US

IV. Provider business mailing address

4101 S MEDFORD DR
LUFKIN TX
75901-5633
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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberH8939
License Number StateTX

VIII. Authorized Official

Name: TERI SMITH
Title or Position: REVENUE CYCLE ADMINISTER
Credential:
Phone: 936-633-5651