=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841475415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BURLESON FAMILY MEDICAL CENTER, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2008
-----------------------------------------------------
Last Update Date | 03/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 434 SW WILSHIRE BLVD
-----------------------------------------------------
City | BURLESON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76028-5330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-447-1208
-----------------------------------------------------
Fax | 817-447-1106
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 434 SW WILSHIRE BLVD
-----------------------------------------------------
City | BURLESON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76028-5330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-447-1208
-----------------------------------------------------
Fax | 817-447-1106
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. M J BARFIELD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-447-1208
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------