Basic Information
| Provider Information | |||||||||
| NPI: | 1871668780 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BURGESS HEALTH CENTER | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 DIAMOND ST | ||||||||
| Address2: | |||||||||
| City: | ONAWA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 510401548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7124232311 | ||||||||
| FaxNumber: | 7124233500 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 DIAMOND ST | ||||||||
| Address2: | |||||||||
| City: | ONAWA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 510401548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7124232311 | ||||||||
| FaxNumber: | 7124233500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | BEHNE | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7124232311 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BURGESS HEALTH CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 670082H | IA | N | Hospital Units | Medicare Defined Swing Bed Unit | 282NC0060X | 670082H | IA | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 0655381 | 05 | IA | MEDICAID |