MEDICARE: MEAGAN BERTNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	04271	IA

General Provider Information

NPI Number	:	1356546675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEAGAN BERTNESS LLC

Provider Business Mailing Address
First Line	:	3126 SUMMIT ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-3946
Country	:	US
Telephone Number	:	712-898-0030
Fax Number	:

Provider Business Practice Location Address
First Line	:	3126 SUMMIT ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-3946
Country	:	US
Telephone Number	:	712-898-0030
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MEAGAN ARCHER
Credential	:
Telephone Number	:	712-898-0030

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	08/22/2020

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