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General NPI Number Information
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NPI Number | 1447257571
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Entity Type | Individual
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Provider Name | SUSAN MARY BURKHART M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 801 KIDWELL DRIVE ST MARY'S CLINIC
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City | VERSAILLES
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State | MO
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Zip | 65084
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Country | US
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Telephone | 573-378-5454
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Fax | 573-378-5055
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Provider Business Mailing Address
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Address Line | P.O. BOX 1027
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City | JEFFERSON CITY
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State | MO
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Zip | 65102-1027
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Country | US
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Telephone | 573-761-7246
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Fax | 573-761-6947
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 104938
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 104938
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License Number State | MO
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