=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164530929
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANNA C BURSON, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 GRAND AVE
-----------------------------------------------------
City | ARDMORE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73401-4343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-226-9994
-----------------------------------------------------
Fax | 580-226-9998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 720 GRAND AVE
-----------------------------------------------------
City | ARDMORE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73401-4343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-226-9994
-----------------------------------------------------
Fax | 580-226-9998
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANNA B BURSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 580-226-9994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 21475
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number | 21475
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------