Healthcare Provider Details

I. General information

NPI: 1710050661
Provider Name (Legal Business Name): BURGESS HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
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: 712-423-9265
  • Fax: 712-423-9199
Mailing address:
  • Phone: 712-423-2311
  • Fax: 712-423-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number081001
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberNONE
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier67146
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBCBS HOMES HEALTH
# 2
Identifier0671461
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 3
Identifier34605
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBCBS WELLMARK HIT 34605

VIII. Authorized Official

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