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General NPI Number Information
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NPI Number | 1548345838
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Entity Type | Organization
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Legal Business Name | BERWALD SURGICAL MEDICAL INC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3478 BRIDGELAND DR STE 2
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City | BRIDGETON
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State | MO
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Zip | 63044-2619
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Country | US
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Telephone | 314-739-8200
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Fax | 314-739-8261
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Provider Business Mailing Address
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Address Line | 3478 BRIDGELAND DR STE 2
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City | BRIDGETON
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State | MO
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Zip | 63044-2619
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRUCE BERWALD
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Credential | MD
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Telephone | 314-739-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 114322
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License Number State | MO
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