MEDICARE: BURNS PROFESSIONAL OFFICE

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1578866547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURNS PROFESSIONAL OFFICE

Provider Business Mailing Address
First Line	:	4503 TEXAS BLVD
Second Line	:	BURNS PROFRESSIONAL OFFICE
City	:	TEXARKANA
State	:	TX
Zip	:	75503
Country	:	US
Telephone Number	:	903-792-4003
Fax Number	:	903-792-2230

Provider Business Practice Location Address
First Line	:	4503 TEXAS BLVD
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-3026
Country	:	US
Telephone Number	:	903-792-4003
Fax Number	:	903-792-2230

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	REBECCA BURNS
Credential	:
Telephone Number	:	903-792-4003

Provider Enumeration Date	:	12/14/2010
Last Update Date	:	12/14/2010

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Directions to “BURNS PROFESSIONAL OFFICE ” Practice Location

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