MEDICARE: PAMELA J DEBERGHES MD

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	207Q00000X	Family Medicine Physician	36309	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	129535	OTHER	BLUE CROSS BLUE SHIELD
2	2140388	OTHER	CIGNA
3	440546366	OTHER	UNITED HEALTHCARE
4	1868943	OTHER	FIRST HEALTH

General Provider Information

NPI Number	:	1952360380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA J DEBERGHES MD

Provider Business Mailing Address
First Line	:	1675 GARDEN OF THE GODS RD
Second Line	:	SUITE 1053 EPC EMPLOYEE HEALTH CENTER
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-9444
Country	:	US
Telephone Number	:	719-520-7600
Fax Number	:	719-520-7610

Provider Business Practice Location Address
First Line	:	5850 CHAMPIONSHIP VW STE D
Second Line	:	EL PASO COUNTY EMPLOYEE HEALTH CENTER
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-2506
Country	:	US
Telephone Number	:	719-520-7600
Fax Number	:	719-520-7610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	11/17/2016

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