Healthcare Provider Details

I. General information

NPI: 1215965611
Provider Name (Legal Business Name): DEGEN-BERGLUND, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 GREEN BAY ST
LA CROSSE WI
54601
US

IV. Provider business mailing address

PO BOX 3157
LA CROSSE WI
54602-3157
US

V. Phone/Fax

Practice location:
  • Phone: 608-775-8571
  • Fax: 608-775-8578
Mailing address:
  • Phone: 608-775-8500
  • Fax: 608-775-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number8773-042
License Number StateWI

VIII. Authorized Official

Name: DANIEL RECKASE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 608-775-8500