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General NPI Number Information
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NPI Number | 1356499784
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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 | 01/08/2007
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Last Update Date | 10/10/2024
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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 |
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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 | 715-463-5317
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Fax |
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Authorized Official
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Title or Position | MEDICAL PRACTICE ADMINISTRATOR
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Name | TAMRA WHITE
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Credential |
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Telephone | 715-463-7210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1034
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1034
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1034
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 1034
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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