Provider Demographics
NPI:1386836559
Name:BURGESS HEALTH CENTER
Entity Type:Organization
Organization Name:BURGESS HEALTH CENTER
Other - Org Name:BURGESS FAMILY CLINIC - DECATUR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:P
Authorized Official - Last Name:BEHNE
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 1:823 S BROADWAY ST STE 120
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:NE
Practice Address - Zip Code:68020-2000
Practice Address - Country:US
Practice Address - Phone:402-349-5592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BURGESS HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-13
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0119958Medicaid