Provider Demographics
NPI:1073605465
Name:BURGEST CLINIC PA
Entity Type:Organization
Organization Name:BURGEST CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:BURGEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-970-4941
Mailing Address - Street 1:PO BOX 268866
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8866
Mailing Address - Country:US
Mailing Address - Phone:254-213-4322
Mailing Address - Fax:254-213-4337
Practice Address - Street 1:840 PROSPECTOR TRL
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-2700
Practice Address - Country:US
Practice Address - Phone:254-213-4322
Practice Address - Fax:254-213-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9637207LH0002X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2009250-01Medicaid
TX7467000001Medicare NSC
TX00Y529Medicare PIN