MEDICARE: BURTON PROSTHETICS INC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	08983	OTHER	NE	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	82-00386	OTHER	NE	UNITED HEALTH CARE

NPI Number	:	1336140011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURTON PROSTHETICS INC

Provider Business Mailing Address
First Line	:	5329 CENTER ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68106-2338
Country	:	US
Telephone Number	:	402-384-1334
Fax Number	:	402-384-1331

Provider Business Practice Location Address
First Line	:	5329 CENTER ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68106-2338
Country	:	US
Telephone Number	:	402-384-1334
Fax Number	:	402-384-1331

Authorized Official
Title or Position	:	CERTIFIED PROSTHETIST/ORTHOTIST
Name	:	MR. RUSSELL F. BURTON
Credential	:	CPO
Telephone Number	:	402-384-1334

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	11/09/2011

8200 DODGE STREET , CHILDREN'S HOSPITAL & MEDICARE CENTER
OMAHA, NE
68114-4113

Practice Phone: 402-955-6140
Practice Fax: 402-955-3398