=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174771760
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BURTON MEDICAL CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2008
-----------------------------------------------------
Last Update Date | 09/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 129 E STARLING ST
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38701-4725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-378-3600
-----------------------------------------------------
Fax | 662-335-3712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 129 E STARLING ST
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38701-4725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-378-3600
-----------------------------------------------------
Fax | 662-335-3712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ELMERTHA D BURTON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 662-378-3600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 11258
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------