Basic Information
| Provider Information | |||||||||
| NPI: | 1700856531 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | RANDALL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 12/11/2009 | ||||||||
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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 | 207RC0000X | 10936 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 10936 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 060037256 | 01 | RAILROAD MEDICARE | OTHER | 3333981 | 05 | TN | MEDICAID | 510-49209 | 01 | AL | BCBS | OTHER | 515-99670 | 01 | AL | BCBS | OTHER | 112203 | 05 | AL | MEDICAID | 515-98499 | 01 | AL | BCBS | OTHER | P00765705 | 01 | AL | RAILROAD MEDICARE | OTHER | 000031072 | 05 | AL | MEDICAID | 0176831 | 01 | TN | BCBS | OTHER | 510-49206 | 01 | AL | BCBS | OTHER | 510-49207 | 01 | AL | BCBS | OTHER | 112189 | 05 | AL | MEDICAID | 112202 | 05 | AL | MEDICAID | 25-10204 | 01 | UNITED HEALTHCARE | OTHER | 510-49208 | 01 | AL | BCBS | OTHER | 51031072 | 01 | AL | BCBS | OTHER | 112193 | 05 | AL | MEDICAID | 112192 | 05 | AL | MEDICAID | 4121926 | 01 | AETNA | OTHER | 112190 | 05 | AL | MEDICAID |