Provider Demographics
NPI:1568469559
Name:CONROE URGENT CARE CLINIC
Entity type:Organization
Organization Name:CONROE URGENT CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:C.
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-494-1110
Mailing Address - Street 1:2129 W .DAVIS ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2050
Mailing Address - Country:US
Mailing Address - Phone:936-494-1110
Mailing Address - Fax:936-494-1115
Practice Address - Street 1:2129 W DAVIS ST
Practice Address - Street 2:STE D
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2050
Practice Address - Country:US
Practice Address - Phone:936-494-1110
Practice Address - Fax:936-494-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4196207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00688YMedicare ID - Type Unspecified