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General NPI Number Information
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NPI Number | 1972731495
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Entity Type | Organization
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Legal Business Name | BALCONES HEALTHCARE ASSOCIATES, PA
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Dates
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Enumeration Date | 06/23/2009
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Last Update Date | 01/25/2011
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Provider Practice Location Address
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Address Line | 200 COUNTY ROAD 340A BUILDING 1, SUITE 4
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City | BURNET
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State | TX
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Zip | 78611-4537
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Country | US
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Telephone | 512-868-4352
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Fax | 512-868-4354
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Provider Business Mailing Address
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Address Line | PO BOX 268969
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City | OKLAHOMA CITY
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State | OK
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Zip | 73126-8969
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Country | US
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Telephone | 512-868-4352
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Fax | 512-868-4354
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SEAN G. BURGEST
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Credential | M.D.
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Telephone | 512-868-4352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | L9637
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License Number State | TX
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