Provider Demographics
NPI:1932308228
Name:CAPITAL CITY ORTHOPAEDICS PA
Entity Type:Organization
Organization Name:CAPITAL CITY ORTHOPAEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-617-1989
Mailing Address - Street 1:12201 RENFERT WAY STE 370
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5376
Mailing Address - Country:US
Mailing Address - Phone:512-617-1989
Mailing Address - Fax:512-617-2065
Practice Address - Street 1:12201 RENFERT WAY STE 370
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5376
Practice Address - Country:US
Practice Address - Phone:512-617-1989
Practice Address - Fax:512-617-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9638207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y453Medicare PIN
TX6649650001Medicare NSC