Basic Information
| Provider Information | |||||||||
| NPI: | 1417242371 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BURCH PSYCHIATRIC SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 219 AIKEN HUNT CIR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292238408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034199070 | ||||||||
| FaxNumber: | 8037793548 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 ALPINE CIR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292236385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037793548 | ||||||||
| FaxNumber: | 8037797055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2011 | ||||||||
| LastUpdateDate: | 06/17/2011 | ||||||||
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| AuthorizedOfficialLastName: | BURCH | ||||||||
| AuthorizedOfficialFirstName: | EARL | ||||||||
| AuthorizedOfficialMiddleName: | ALLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 8034199070 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | 8023 | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.