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General NPI Number Information
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NPI Number | 1679949424
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Entity Type | Organization
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Legal Business Name | CONTINUED CARE PARTNERS PA
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 3100 CARLISLE ST SUITE 2112
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City | DALLAS
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State | TX
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Zip | 75204-1358
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Country | US
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Telephone | 469-930-4305
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Fax | 469-930-4311
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Provider Business Mailing Address
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Address Line | 3100 CARLISLE ST SUITE 2112
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City | DALLAS
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State | TX
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Zip | 75204-1358
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Country | US
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Telephone | 469-930-4305
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Fax | 469-930-4311
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | TY BURGESS
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Credential |
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Telephone | 469-930-4305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N2137
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License Number State | TX
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