Organization
TULLAHOMA UROLOGY CENTER, P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK LLOYD BURSON M.D. (OWNER)
(931) 454-1955
Entity
Organization
Contact information
Practice address
107 LEDFORD MILL RD, SUITE 210, TULLAHOMA, TN 37388-2278
(931) 454-1955
(931) 454-1956
Mailing address
PO BOX 1718, TULLAHOMA, TN 37388-1718
(931) 454-1955
(931) 454-1956
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
40439
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4116328
BCBS/TN
TN
Enumeration date
11/15/2005
Last updated
06/17/2010
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