Healthcare Provider Details

I. General information

NPI: 1386836559
Provider Name (Legal Business Name): BURGESS HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 S BROADWAY ST STE 120
DECATUR NE
68020-2000
US

IV. Provider business mailing address

1600 DIAMOND ST
ONAWA IA
51040-1548
US

V. Phone/Fax

Practice location:
  • Phone: 402-349-5592
  • Fax:
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 State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. CARL P BEHNE
Title or Position: CEO
Credential:
Phone: 712-423-2311