Provider Demographics
NPI:1699844548
Name:BURGESS HEALTH CENTER
Entity Type:Organization
Organization Name:BURGESS HEALTH CENTER
Other - Org Name:WHITING FAMILY PHARMACY
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 1:723 WHITTIER ST
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:IA
Mailing Address - Zip Code:51063-1035
Mailing Address - Country:US
Mailing Address - Phone:712-458-2500
Mailing Address - Fax:712-458-2963
Practice Address - Street 1:723 WHITTIER ST
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IA
Practice Address - Zip Code:51063-1035
Practice Address - Country:US
Practice Address - Phone:712-458-2500
Practice Address - Fax:712-458-2963
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BURGESS HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
IA11003336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0197228Medicaid
2029899OtherPK
2029899OtherPK
2029899OtherPK