Basic Information
| Provider Information | |||||||||
| NPI: | 1477502631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURCH | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7687 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652057687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738822259 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3301 S PROVIDENCE RD | ||||||||
| Address2: | BLDG E | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652033624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738822511 | ||||||||
| FaxNumber: | 5738844515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 12/24/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD108310 | MO | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1583207 | 01 | MO | UNITED HEALTHCARE | OTHER | 2086826501 | 01 | MO | KANSAS MEDICAID | OTHER | 415917 | 01 | MO | HEALTHLINK | OTHER | 118801 | 01 | MO | BLUE CHOICE | OTHER | 118801 | 01 | MO | BLUE SHIELD | OTHER |