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General NPI Number Information
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NPI Number | 1770767782
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Entity Type | Organization
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Legal Business Name | BERG MEDICAL CLINIC PC
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 221 CALUMET AVE SW
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City | DE SMET
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State | SD
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Zip | 57231
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Country | US
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Telephone | 605-854-9100
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Fax | 605-854-9238
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Provider Business Mailing Address
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Address Line | 221 CALUMET AVE SW
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City | DE SMET
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State | SD
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Zip | 57231
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Country | US
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Telephone | 605-854-9100
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Fax | 605-854-9238
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JANELLE SCHUBLOOM
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Credential |
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Telephone | 605-854-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | SD 4247
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License Number State | SD
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