Basic Information
| Provider Information | |||||||||
| NPI: | 1013134469 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUMBURG | ||||||||
| FirstName: | BURT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1000 4TH ST SW | ||||||||
| Address2: | |||||||||
| City: | MASON CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504012800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414287000 | ||||||||
| FaxNumber: | 6414286383 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 4TH ST SW | ||||||||
| Address2: | |||||||||
| City: | MASON CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504012800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414287000 | ||||||||
| FaxNumber: | 6414286383 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 01/22/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD431085 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208D00000X | 0431207 | KS | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | 47001 | MN | N | Allopathic & Osteopathic Physicians | General Practice | 208M00000X | MD431085 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 39580 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 930841 | 01 | MD | CAREFIRST MD BCBS | OTHER | 263661 | 01 | PA | UNISON-WMG GBH | OTHER | 100598 | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 50077200 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 1570857 | 01 | PA | GATEWAY-WMG | OTHER | 2024764 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 212420 | 01 | PA | JOHNS HOPKINS | OTHER | 20074392 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 50084012 | 01 | PA | CAPITAL BLUE CROSS-WMG GBH | OTHER | 9989169 | 01 | PA | AETNA | OTHER | 239828 | 01 | PA | UNISON-WMG | OTHER |