Basic Information
| Provider Information | |||||||||
| NPI: | 1184654287 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 32ND AVE S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581036132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013648000 | ||||||||
| FaxNumber: | 7013648078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 05/24/2012 | ||||||||
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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 | 207P00000X | 7016 | ND | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PE0004X | 7016 | ND | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 141997 | 01 | ND | UCARE # | OTHER | DA9011015640 | 01 | ND | PREFERRED ONE # | OTHER | 80D80BU | 01 | ND | MNBS # | OTHER | 0105999 | 01 | ND | MEDICA # | OTHER | 0108130 | 01 | ND | MEDICA # | OTHER | 6D845BU | 01 | ND | MNBS # | OTHER | ND200224 | 01 | ND | LHS # | OTHER | 12051 | 01 | ND | SIOUX VALLEY # | OTHER | 18193 | 05 | ND | MEDICAID | 3901622 | 01 | ND | MEDICA # | OTHER | 02T32BU | 01 | ND | MNBS # | OTHER | 21580 | 01 | ND | NDBS # | OTHER | 166217100 | 05 | ND | MEDICAID | 14746 | 01 | ND | NDBS # | OTHER | 900338 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER | HP19520 | 01 | ND | HEALTHPARTNERS # | OTHER |