Provider Demographics
NPI:1568548683
Name:BURLESON LEASE CORP
Entity Type:Organization
Organization Name:BURLESON LEASE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PFS TEAM LEADER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-567-3245
Mailing Address - Street 1:1101 WOODSON DR
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:TX
Mailing Address - Zip Code:77836-1052
Mailing Address - Country:US
Mailing Address - Phone:979-567-3245
Mailing Address - Fax:
Practice Address - Street 1:1101 WOODSON DR
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-1052
Practice Address - Country:US
Practice Address - Phone:979-567-3245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451305Medicare ID - Type Unspecified