Provider Demographics
NPI:1962856161
Name:PAM PHYSICIAN ENTERPRISE
Entity Type:Organization
Organization Name:PAM PHYSICIAN ENTERPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO/AUTHORIZED DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BURICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-317-9313
Mailing Address - Street 1:PO BOX 206478
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-1233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4671 38TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7866
Practice Address - Country:US
Practice Address - Phone:701-540-9544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty