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General NPI Number Information
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NPI Number | 1215965611
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Entity Type | Organization
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Legal Business Name | DEGEN-BERGLUND, INC
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2441 GREEN BAY ST
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City | LA CROSSE
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State | WI
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Zip | 54601
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Country | US
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Telephone | 608-775-8571
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Fax | 608-775-8578
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Provider Business Mailing Address
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Address Line | PO BOX 3157
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City | LA CROSSE
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State | WI
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Zip | 54602-3157
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Country | US
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Telephone | 608-775-8500
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Fax | 608-775-8555
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DANIEL RECKASE
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Credential |
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Telephone | 608-775-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | 8773-042
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License Number State | WI
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