Provider Demographics
NPI:1609041888
Name:BURROUGHS MEDICAL CLINIC, PA
Entity Type:Organization
Organization Name:BURROUGHS MEDICAL CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURROUGHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-897-3310
Mailing Address - Street 1:PO BOX 2730
Mailing Address - Street 2:
Mailing Address - City:GLEN ROSE
Mailing Address - State:TX
Mailing Address - Zip Code:76043-2730
Mailing Address - Country:US
Mailing Address - Phone:254-897-3310
Mailing Address - Fax:254-897-9973
Practice Address - Street 1:1008 NE BIG BEND TRL
Practice Address - Street 2:
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043-4912
Practice Address - Country:US
Practice Address - Phone:254-897-3310
Practice Address - Fax:254-897-9973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1901207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0097RHOtherBLUE CROSS BLUE SHIELD TEXAS
TX0097RHOtherBLUE CROSS BLUE SHIELD TEXAS