Provider Demographics
NPI:1750388294
Name:BURCH, CHAD (PA-C)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:BURCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23330 HWY 59 N STE 300
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-4471
Mailing Address - Country:US
Mailing Address - Phone:713-409-9525
Mailing Address - Fax:281-359-2089
Practice Address - Street 1:23330 US - 59
Practice Address - Street 2:SUITE 300
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-359-3223
Practice Address - Fax:281-359-2089
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04723363A00000X, 363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1750388294OtherTRICARE SOUTH
TX304423202Medicaid
TX8N0137OtherBCBS-TX
TX8N0137OtherBCBS-TX
TXTXB159481Medicare PIN
TX8N0137OtherBCBS-TX