Provider Demographics
NPI:1932124732
Name:BURWELL FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:BURWELL FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:HOLMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-346-5544
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:BURWELL
Mailing Address - State:NE
Mailing Address - Zip Code:68823-0906
Mailing Address - Country:US
Mailing Address - Phone:308-346-5544
Mailing Address - Fax:308-346-4744
Practice Address - Street 1:410 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:BURWELL
Practice Address - State:NE
Practice Address - Zip Code:68823-5254
Practice Address - Country:US
Practice Address - Phone:308-346-5544
Practice Address - Fax:308-346-4744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19518261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========20Medicaid
NE283836Medicare PIN
NE099017Medicare PIN