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BRUCE K BURTON MD PA NPI 1376639344


NPI Information

NPI: 1376639344
Provider Name: BRUCE K BURTON MD PA

Doing Business As: MALVERN DIAGNOSTIC CLINIC

Classification: Clinic/Center - 261Q00000X
Entity Type: Organization

CLIA Number: 04D0466450

Address:
2223 GRANT STREET
MALVERN, AR
ZIP 72104
Phone: (501) 337-9031
Get Directions

BRUCE K BURTON MD PA is a clinic center in Malvern, AR. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). BRUCE K BURTON MD PA NPI is 1376639344. The provider is registered as an organization entity type.
The provider Is Doing Business As Malvern Diagnostic Clinic.

The provider's business location address is:

2223 GRANT STREET
MALVERN, AR
ZIP 72104
Phone: (501) 337-9031
Fax: (501) 337-9033

The provider's authorized official is Bruce Kent Burton .
The authorized official title is PRESIDENT OWNEROwner and has the following contact phone number (501) 337-9031.

The CLIA number assigned to this NPI record is 04D0466450 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/5/2006 and was last updated on 11/18/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261Q00000XClinic/CenterMC 0784ARKANSASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
157801OTHERARKANSASBCBS
257801MEDICARE ID-TYPE UNSPECIFIED
3110030002MEDICAIDARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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