MEDICARE: BURKS MEDICAL CONSULTING

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1215240916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURKS MEDICAL CONSULTING

Provider Business Mailing Address
First Line	:	305 REGENCY PKWY
Second Line	:	413
City	:	MANSFIELD
State	:	TX
Zip	:	76063-3794
Country	:	US
Telephone Number	:	682-518-9300
Fax Number	:	817-473-9272

Provider Business Practice Location Address
First Line	:	305 REGENCY PKWY
Second Line	:	413
City	:	MANSFIELD
State	:	TX
Zip	:	76063-3794
Country	:	US
Telephone Number	:	682-518-9300
Fax Number	:	817-473-9272

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. CONNIE F BURKS
Credential	:
Telephone Number	:	682-518-9300

Provider Enumeration Date	:	07/22/2010
Last Update Date	:	07/22/2010

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