MEDICARE: BURWELL FAMILY PRACTICE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center	19518	NE

General Provider Information

NPI Number	:	1932124732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURWELL FAMILY PRACTICE PC

Provider Business Mailing Address
First Line	:	PO BOX 906
Second Line	:
City	:	BURWELL
State	:	NE
Zip	:	68823-0906
Country	:	US
Telephone Number	:	308-346-5544
Fax Number	:	308-346-4744

Provider Business Practice Location Address
First Line	:	410 S 8TH AVE
Second Line	:
City	:	BURWELL
State	:	NE
Zip	:	68823-5254
Country	:	US
Telephone Number	:	308-346-5544
Fax Number	:	308-346-4744

Authorized Official
Title or Position	:	CORPORATE PRESIDENT
Name	:	HUGH RALPH HOLMQUIST
Credential	:	M.D.
Telephone Number	:	308-346-5544

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	11/29/2011

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Directions to “BURWELL FAMILY PRACTICE PC ” Practice Location

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