MEDICARE: BURGEST CLINIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LH0002X	Hospice and Palliative Medicine (Anesthesiology) Physician	L9637	TX
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	L9637	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073605465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURGEST CLINIC PA

Provider Business Mailing Address
First Line	:	PO BOX 268866
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-8866
Country	:	US
Telephone Number	:	254-213-4322
Fax Number	:	254-213-4337

Provider Business Practice Location Address
First Line	:	840 PROSPECTOR TRL
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2700
Country	:	US
Telephone Number	:	254-213-4322
Fax Number	:	254-213-4337

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. SEAN GREGORY BURGEST
Credential	:	MD
Telephone Number	:	512-970-4941

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	04/01/2016

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Directions to “BURGEST CLINIC PA ” Practice Location

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