Provider Demographics
NPI:1174771760
Name:BURTON MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:BURTON MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELMERTHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-378-3600
Mailing Address - Street 1:129 E STARLING ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-4725
Mailing Address - Country:US
Mailing Address - Phone:662-378-3600
Mailing Address - Fax:662-335-3712
Practice Address - Street 1:129 E STARLING ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4725
Practice Address - Country:US
Practice Address - Phone:662-378-3600
Practice Address - Fax:662-335-3712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11258261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSB45837Medicare UPIN