MEDICARE: CONTINUED CARE PARTNERS 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	207R00000X	Internal Medicine Physician	N2137	TX

General Provider Information

NPI Number	:	1679949424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONTINUED CARE PARTNERS PA

Provider Business Mailing Address
First Line	:	3100 CARLISLE ST
Second Line	:	SUITE 2112
City	:	DALLAS
State	:	TX
Zip	:	75204-1358
Country	:	US
Telephone Number	:	469-930-4305
Fax Number	:	469-930-4311

Provider Business Practice Location Address
First Line	:	3100 CARLISLE ST
Second Line	:	SUITE 2112
City	:	DALLAS
State	:	TX
Zip	:	75204-1358
Country	:	US
Telephone Number	:	469-930-4305
Fax Number	:	469-930-4311

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	TY BURGESS
Credential	:
Telephone Number	:	469-930-4305

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	08/17/2015

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Directions to “CONTINUED CARE PARTNERS PA ” Practice Location

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