Burckhard Clinic, P. C.

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

120 Issued in ND

Legal business name

BURCKHARD CLINIC, P. C.

Practice address

315 Main St S Ste 315
Ste. 315
Minot, ND 58701-3956

Phone

(701) 852-5876

Fax

(701) 852-5883

NPI assigned

Dec 22, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mike V. Burckhard, LICSWNPI 1104814789

Title

Clinical Director

Phone

(701) 852-5876

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mike Vincent Burckhard, LICSW

  • Mental Health Counselor
  • Minot, ND
  • NPI 1104814789
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416355200000",
    "number": "1346305190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 MAIN ST S STE 315",
            "address_2": "STE. 315",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587013956",
            "telephone_number": "701-852-5876",
            "fax_number": "701-852-5883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 MAIN ST S STE 315",
            "address_2": "STE. 315",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587013956",
            "telephone_number": "701-852-5876",
            "fax_number": "701-852-5883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURCKHARD CLINIC, P. C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2014-11-19",
        "status": "A",
        "authorized_official_last_name": "BURCKHARD",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "701-852-5876",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "ND",
            "license": "120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11482",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Boom Buckner, CCC-SLP
• Meredith Poynot Budgeon, AU.D.
• Brett J Buican, PHD
• Christine Ann Burcham
• Kristy Burchell
• Burckhard Orthodontics, PLLC
• Tifany A Burckhard-Teets, DC
• Andrea Marie Burckhard, D.C.
• Jason Burckhard, DDS
• Kathryn Marie Burckhard

• Adult Mental Health Clinic/Center in Minot, ND
• Providers in Minot, ND by specialty
• Adult Mental Health Clinic/Center in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.