MEDICARE: BERTRAM DEVELOPMENT COMPANY 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	313M00000X	Nursing Facility/Intermediate Care Facility	115364	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00452202	OTHER	TX	VENDOR NUMBER

General Provider Information

NPI Number	:	1558305672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERTRAM DEVELOPMENT COMPANY INC

Provider Business Mailing Address
First Line	:	PO BOX 1615
Second Line	:
City	:	BERTRAM
State	:	TX
Zip	:	78605-1615
Country	:	US
Telephone Number	:	512-355-2116
Fax Number	:	512-355-2092

Provider Business Practice Location Address
First Line	:	540 HIGHWAY 29 EAST
Second Line	:
City	:	BERTRAM
State	:	TX
Zip	:	78605-1615
Country	:	US
Telephone Number	:	512-355-2116
Fax Number	:	512-355-2092

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. DENNIS RAY BAKER JR.
Credential	:	LNFA
Telephone Number	:	512-355-2116

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	04/01/2008

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Directions to “BERTRAM DEVELOPMENT COMPANY INC ” Practice Location

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