Healthcare Provider Details

I. General information

NPI: 1538234232
Provider Name (Legal Business Name): BURGESS HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DIAMOND ST
ONAWA IA
51040-1548
US

IV. Provider business mailing address

1600 DIAMOND ST
ONAWA IA
51040-1548
US

V. Phone/Fax

Practice location:
  • Phone: 712-423-2311
  • Fax: 712-423-9199
Mailing address:
  • Phone: 712-423-2311
  • Fax: 712-423-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: LYNN R WOLD
Title or Position: CEO
Credential:
Phone: 712-423-2311