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General NPI Number Information
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NPI Number | 1235742115
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Entity Type | Organization
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Legal Business Name | BERGER BUILT CONSTRUCTION CO. INC.
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 217 MAPLE STREET
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City | MAHTOMEDI
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State | MN
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Zip | 55115
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Country | US
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Telephone | 612-865-5726
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Fax |
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Provider Business Mailing Address
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Address Line | 217 MAPLE STREET
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City | MAHTOMEDI
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State | MN
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Zip | 55115
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Country | US
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Telephone | 612-865-5726
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAY GERALD BERGER
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Credential |
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Telephone | 612-865-5726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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