Provider Demographics
NPI:1780637678
Name:BURGESS HEALTH CENTER
Entity Type:Organization
Organization Name:BURGESS HEALTH CENTER
Other - Org Name:BURGESS FAMILY CLINIC - DUNLAP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:TRAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-423-9206
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:712-423-9213
Mailing Address - Fax:712-423-9327
Practice Address - Street 1:612 IOWA AVE
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:IA
Practice Address - Zip Code:51529-1334
Practice Address - Country:US
Practice Address - Phone:712-643-5880
Practice Address - Fax:712-643-5881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BURGESS HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207Q00000X, 208D00000X, 363L00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5175414Medicaid
IA0634865Medicaid
IA0431866Medicaid
IA4175414Medicaid
IA0431866Medicaid
IAI12107Medicare PIN