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General NPI Number Information
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NPI Number | 1225191687
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Entity Type | Organization
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Legal Business Name | BURNETT MEDICAL CENTER INC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 257 W SAINT GEORGE AVE
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City | GRANTSBURG
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State | WI
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Zip | 54840-7827
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Country | US
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Telephone | 715-463-5353
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Fax | 715-463-2423
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Provider Business Mailing Address
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Address Line | 257 W SAINT GEORGE AVE
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City | GRANTSBURG
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State | WI
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Zip | 54840-7827
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Country | US
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Telephone | 715-463-5353
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Fax | 715-463-2423
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Authorized Official
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Title or Position | CFO
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Name | MR. CHARLES J. FAUGHT
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Credential |
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Telephone | 715-463-7281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 1034
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License Number State | WI
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