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General NPI Number Information
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NPI Number | 1922354539
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Entity Type | Individual
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Provider Name | WADE SCOTT BERGER MBA, CCP, SA-C
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Gender | Male
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 2203 WOODMEN DR
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City | SAN ANTONIO
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State | TX
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Zip | 78209-4278
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Country | US
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Telephone | 979-743-0508
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Fax |
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Provider Business Mailing Address
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Address Line | 2203 WOODMEN DR
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City | SAN ANTONIO
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State | TX
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Zip | 78209-4278
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Country | US
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Telephone | 979-743-0508
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 15593
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 242T00000X
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Taxonomy Name | Perfusionist
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License Number | FPF00001162
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License Number State | TX
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