Healthcare Provider Details

I. General information

NPI: 1699844548
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: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 WHITTIER ST
WHITING IA
51063-1035
US

IV. Provider business mailing address

723 WHITTIER ST
WHITING IA
51063-1035
US

V. Phone/Fax

Practice location:
  • Phone: 712-458-2500
  • Fax: 712-458-2963
Mailing address:
  • Phone: 712-458-2500
  • Fax: 712-458-2963

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 Number1100
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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