Healthcare Provider Details

I. General information

NPI: 1487022216
Provider Name (Legal Business Name): BURGESS HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 BLAIR ST
WHITING IA
51063-1007
US

IV. Provider business mailing address

1600 DIAMOND ST
ONAWA IA
51040-1548
US

V. Phone/Fax

Practice location:
  • Phone: 712-455-2431
  • Fax: 712-455-2698
Mailing address:
  • Phone: 712-423-2311
  • Fax: 712-423-9199

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 StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

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