Healthcare Provider Details

I. General information

NPI: 1780637678
Provider Name (Legal Business Name): BURGESS HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 IOWA AVE
DUNLAP IA
51529-1334
US

IV. Provider business mailing address

1600 DIAMOND ST
ONAWA IA
51040-1548
US

V. Phone/Fax

Practice location:
  • Phone: 712-643-5880
  • Fax: 712-643-5881
Mailing address:
  • Phone: 712-423-9213
  • Fax: 712-423-9327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateIA

VIII. Authorized Official

Name: MR. FRANCIS G TRAMP
Title or Position: CEO/PRESIDENT
Credential:
Phone: 712-423-9206