Basic Information
| Provider Information | |||||||||
| NPI: | 1861134546 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BURKE HOSPITAL COMPANY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BURKE CARDIOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 351 S LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 308309686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065544435 | ||||||||
| FaxNumber: | 7065544854 | ||||||||
| Practice Location | |||||||||
| Address1: | 411 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 308301511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067022667 | ||||||||
| FaxNumber: | 7062622988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2022 | ||||||||
| LastUpdateDate: | 10/03/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HESTER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9123699400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BURKE HOSPITAL COMPANY | ||||||||
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| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.