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1174593446

NPI Code Detail

MEDICARE: DR. MARY JANELL BURCH M.D.

MEDICARE: DR. MARY JANELL BURCH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	C7669	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	080048089	OTHER	AR	RAILROAD MEDICARE/PALMETT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1670796	OTHER	AR	UNITED HEALTHCARE
2	0790780001	OTHER	AR	PALMETTO GBA
3	15356000000	OTHER	AR	QUALCHOICE
4	XX12984	OTHER	AR	HEALTH PLUS OF MICHIGAN
5	510436	OTHER	AR	HEALTH LINK
6	020407900	OTHER	AR	BLACK LUNG PROGRAM
8	7345105	OTHER	AR	AETNA INSURANCE COMPANY
9	0062731	OTHER	AR	UMWA H&R FUNDS
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	54227	OTHER	AR	BLUECROSSBLUESHIELD ARK

General Provider Information

NPI Number	:	1174593446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY JANELL BURCH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 668
Second Line	:
City	:	CLARKSVILLE
State	:	AR
Zip	:	72830-0668
Country	:	US
Telephone Number	:	479-754-8384
Fax Number	:	479-754-7141

Provider Business Practice Location Address
First Line	:	601 W MCKENNON ST
Second Line	:
City	:	CLARKSVILLE
State	:	AR
Zip	:	72830-3523
Country	:	US
Telephone Number	:	479-754-8384
Fax Number	:	479-754-7141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	06/26/2025

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Practice Location Address:

601 W MCKENNON ST
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1245200971 — DR. KIM GRAVES M.D.
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1083684740 — SUSAN GATELEY A.P.N.
Practice Location Address:

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72830-3523

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1770553448 — DR. LINDSEY J PREWITT M.D.
Practice Location Address:

601 W MCKENNON ST
CLARKSVILLE, AR
72830-3523

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Practice Fax: 479-754-7141

1487624896 — DR. JOHN C DUNHAM M.D.
Practice Location Address:

601 W MCKENNON ST
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72830-3523

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1164482162 — JAMES BRIAN COTNER MD
Practice Location Address:

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Directions to “ DR. MARY JANELL BURCH M.D.” Practice Location

Language	Start Address	Practice Location

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