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J. Kenneth
Burkus
MD
Contract Details
Hughston Clinic--Columbus
Facility name
Provider ID
P000000227
NPI
1083656839
Tax ID
581155460
Effective Date
4/15/2010
Last Updated
9/22/2014
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
M
Exhibit ID
AM_140
AM_140
Location Details
Address
6262 Veterans Parkway
Columbus, GA 31909
United States
County
Muscogee
Phone
7063246661
(
Phone
)
Billing Details
Address
P.O. Box 848249
Boston, MA 02284
Billing Phone
7063246661
Specialty Type
Surgery, Orthopedic
Map
Address