Provider Demographics
NPI:1487022216
Name:BURGESS HEALTH CENTER
Entity type:Organization
Organization Name:BURGESS HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-423-2311
Mailing Address - Street 1:1600 DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:ONAWA
Mailing Address - State:IA
Mailing Address - Zip Code:51040-1548
Mailing Address - Country:US
Mailing Address - Phone:712-423-2311
Mailing Address - Fax:712-423-9199
Practice Address - Street 1:153 BLAIR ST
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IA
Practice Address - Zip Code:51063-1007
Practice Address - Country:US
Practice Address - Phone:712-455-2431
Practice Address - Fax:712-455-2698
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BURGESS HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-10
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA27223Medicare PIN