Healthcare Provider Details

I. General information

NPI: 1881763738
Provider Name (Legal Business Name): BURGESS HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 IOWA AVE
DUNLAP IA
51529-1334
US

IV. Provider business mailing address

612 IOWA AVE
DUNLAP IA
51529-1334
US

V. Phone/Fax

Practice location:
  • Phone: 712-643-5162
  • Fax: 712-643-5807
Mailing address:
  • Phone: 712-643-5162
  • Fax: 712-643-5807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number730
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FRANCIS TRAMP
Title or Position: PRESIDENT
Credential: RPH
Phone: 712-423-9206