Provider Demographics
NPI:1114259520
Name:BLUEBONNET MEDICAL CARE PA
Entity Type:Organization
Organization Name:BLUEBONNET MEDICAL CARE PA
Other - Org Name:ENNIS QUICK CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BART
Authorized Official - Middle Name:W
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-875-9755
Mailing Address - Street 1:2200 PHYSICIANS BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-6247
Mailing Address - Country:US
Mailing Address - Phone:972-875-9755
Mailing Address - Fax:972-905-9175
Practice Address - Street 1:2200 PHYSICIANS BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-6247
Practice Address - Country:US
Practice Address - Phone:972-875-9755
Practice Address - Fax:972-905-9175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care