Healthcare Provider Details

I. General information

NPI: 1972517977
Provider Name (Legal Business Name): MICHAEL SCOTT BERGMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL SCOTT BERGMAN CRNA

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 SOUTHCREST PKWY
SOUTHAVEN MS
38671-4739
US

IV. Provider business mailing address

929 FALLEN OAKS DR
COLLIERVILLE TN
38017-3540
US

V. Phone/Fax

Practice location:
  • Phone: 662-349-4000
  • Fax:
Mailing address:
  • Phone: 901-853-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1322
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberA810193
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number273250-3120
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number200860036
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60225469
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA-899
License Number StateID
# 7
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD161234
License Number StateIA
# 8
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number43557575072
License Number StateKS
# 9
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA000533
License Number StateNV
# 10
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN130636
License Number StateMT
# 11
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number58180
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: