1154497527 NPI number — HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME

Table of content: MRS. MEGAN LINDSEY BERGERON PMHNP (NPI 1649850124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154497527 NPI number — HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154497527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 106
Provider Second Line Business Mailing Address:
503 EAST LINCOLN ST
Provider Business Mailing Address City Name:
HENDRICKS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56136-0106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-275-3134
Provider Business Mailing Address Fax Number:
507-275-2242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 EAST LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDRICKS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56136-0106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-275-3134
Provider Business Practice Location Address Fax Number:
507-275-2242
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOLLAHER
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
507-275-3134

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  330907 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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