Burge, Justin Bryce

Burge, Justin Bryce is an individual health care provider with primary practice located at 415 S 28Th Ave , Hattiesburg MS 39401-7246. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered. Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered is his primary health care specialty. Burge, Justin Bryce can be contacted via phone (601) 261-3606.

Contact Information

Primary practice address
415 S 28Th Ave Hattiesburg MS 39401-7246
Phone: (601) 261-3606
Fax: (601) 579-5383
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X R877664 Mississippi
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 3007275 Kentucky
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X A810475 Mississippi

Profile Details

NPI number 1174808638
LBN Legal business name Burge, Justin Bryce
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 17th, 2011
Last updated Aug 23rd, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174808638 NPPES
Mississippi Other 3539043 UNITED HEALTHCARE
Mississippi Other 9758895 UNITED HEALTHCARE
Mississippi Other 8318378 UNITED HEALTHCARE
Mississippi MEDICAID 01235096 UNITED HEALTHCARE

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