NPIMap

Organization Active NPI

Burroughs Medical Clinic, PA

  • Family Medicine Physician
  • Glen Rose, TX
National Provider Identifier
1609041888
Registry record updated Dec 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
J1901 Issued in TX
Legal business name
BURROUGHS MEDICAL CLINIC, PA
Practice address
1008 NE Big Bend TRL
Glen Rose, TX 76043-4912
Phone
(254) 897-3310
Fax
(254) 897-9973
NPI assigned
Apr 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Karen Burroughs, M.D.
Title
Owner
Phone
(254) 897-3310

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X J1901 TX Primary

Addresses

Primary practice location

1008 NE Big Bend TRL
Glen Rose, TX 76043-4912

Mailing address

PO Box 2730
Glen Rose, TX 76043-2730
Phone (254) 897-3310

Other identifiers 1

IdentifierTypeStateIssuer
0097RHOtherTXBLUE CROSS BLUE SHIELD TEXAS

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417996800000",
    "number": "1609041888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2730",
            "city": "GLEN ROSE",
            "state": "TX",
            "postal_code": "760432730",
            "telephone_number": "254-897-3310",
            "fax_number": "254-897-9973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 NE BIG BEND TRL",
            "city": "GLEN ROSE",
            "state": "TX",
            "postal_code": "760434912",
            "telephone_number": "254-897-3310",
            "fax_number": "254-897-9973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURROUGHS MEDICAL CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-28",
        "last_updated": "2014-12-08",
        "status": "A",
        "authorized_official_last_name": "BURROUGHS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "254-897-3310",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J1901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD TEXAS",
            "identifier": "0097RH",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Rose, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.