Healthcare Provider Details

I. General information

NPI: 1104789874
Provider Name (Legal Business Name): DAVID JAMES BURKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S KANSAS AVE
HASTINGS NE
68901-6130
US

IV. Provider business mailing address

601 S KANSAS AVE
HASTINGS NE
68901-6130
US

V. Phone/Fax

Practice location:
  • Phone: 262-496-8080
  • Fax:
Mailing address:
  • Phone: 262-496-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: