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Organization Active NPI

William Burke LTD

Doing business as Main at Locust Pharmacy and Clinic

  • Clinic Pharmacy
  • Davenport, IA
National Provider Identifier
1851620066
Registry record updated Feb 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
16D0922143 Issued in IA
Legal business name
WILLIAM BURKE LTD
Doing business as
Main at Locust Pharmacy and Clinic
Practice address
129 W Locust St
Davenport, IA 52803-2803
Phone
(563) 324-5004
Fax
(563) 324-3305
NPI assigned
Dec 17, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Andrew Ploehn
Title
Owner
Phone
(563) 324-5004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 16D0922143 IA Primary

Addresses

Primary practice location

129 W Locust St
Davenport, IA 52803-2803

Mailing address

2151 Kimberly Rd
Bettendorf, IA 52722
Phone (563) 324-1641

Other names 1

  • MAIN AT LOCUST PHARMACY AND CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100304000455 IA Part B Supplier - Mass Immunization (Roster Biller Only) 5395644843 Practice locations: Davenport, IA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
William Burke LTD5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

129 W Locust St
Davenport, IA 52803
Phone (563) 324-1641

Ownership & related parties

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Colonial Manor of Columbus CommunityColumbus Junction, IA, CCN 165476 Skilled nursing facility Adp of the SNF Aug 31, 2013
Davenport Lutheran HomeDavenport, IA, CCN 165510 Skilled nursing facility Adp of the SNF Jan 1, 2025
Parkview HomeWayland, IA, CCN 165547 Skilled nursing facility Adp of the SNF Jan 1, 2025
Solon Nursing Care CenterSolon, IA, CCN 165550 Skilled nursing facility Adp of the SNF Aug 12, 2015
Simpson Memorial HomeWest Liberty, IA, CCN 165418 Skilled nursing facility Adp of the SNF Jan 31, 2012
Pleasantview HomeKalona, IA, CCN 165470 Skilled nursing facility Adp of the SNF Aug 12, 2015
Wheatland ManorWheatland, IA, CCN 165377 Skilled nursing facility Adp of the SNF Aug 12, 2015
Wilton Retirement CommunityWilton, IA, CCN 165611 Skilled nursing facility Adp of the SNF
Indirect Ownership Interest		 Jul 31, 2014
Jul 31, 2014

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1261008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708646400000",
    "number": "1851620066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2151 KIMBERLY RD",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "52722",
            "telephone_number": "563-324-1641",
            "fax_number": "563-884-4480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 W LOCUST ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528032803",
            "telephone_number": "563-324-5004",
            "fax_number": "563-324-3305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM BURKE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-17",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A",
        "authorized_official_last_name": "PLOEHN",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "563-324-5004"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "IA",
            "license": "16D0922143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAIN AT LOCUST PHARMACY AND CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.