Provider Demographics
NPI:1538596705
Name:BURLESON COUNTY FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:BURLESON COUNTY FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOVORAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-777-0114
Mailing Address - Street 1:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:TX
Mailing Address - Zip Code:77836-0905
Mailing Address - Country:US
Mailing Address - Phone:979-567-4900
Mailing Address - Fax:
Practice Address - Street 1:1012 WOODSON DR
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-1000
Practice Address - Country:US
Practice Address - Phone:979-567-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4233261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care