MEDICARE: DEGEN BERGLUND INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	332BX2000X	Oxygen Equipment & Supplies (DME)
4	3336C0003X	Community/Retail Pharmacy	9090-042	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5103851	OTHER	WI	NCPDP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427086826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEGEN BERGLUND INC

Provider Business Mailing Address
First Line	:	PO BOX 3157
Second Line	:
City	:	LA CROSSE
State	:	WI
Zip	:	54602-3157
Country	:	US
Telephone Number	:	608-775-8500
Fax Number	:	608-775-8555

Provider Business Practice Location Address
First Line	:	2511 GREEN BAY STREET
Second Line	:
City	:	LA CROSSE
State	:	WI
Zip	:	54601-6155
Country	:	US
Telephone Number	:	608-775-8585
Fax Number	:	608-775-8598

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JON BINGOL
Credential	:
Telephone Number	:	608-775-8500

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	03/07/2023

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