Provider Demographics
NPI:1699444083
Name:CHRONIC COVID CARE PLLC
Entity type:Organization
Organization Name:CHRONIC COVID CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO / CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANNON
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-464-2160
Mailing Address - Street 1:1705 JULIET ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-1422
Mailing Address - Country:US
Mailing Address - Phone:419-464-2160
Mailing Address - Fax:
Practice Address - Street 1:1705 JULIET ST UNIT B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-1422
Practice Address - Country:US
Practice Address - Phone:419-464-2160
Practice Address - Fax:855-541-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty