1164619409 NPI number — KATHERINE J. BERGER, D.P.M.

Table of content: (NPI 1164619409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164619409 NPI number — KATHERINE J. BERGER, D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHERINE J. BERGER, D.P.M.
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:
1164619409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3401 O ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68510-1541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-474-4766
Provider Business Mailing Address Fax Number:
402-474-5957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
747 N BURLINGTON AVE STE 308
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HASTINGS
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68901-4478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-462-2331
Provider Business Practice Location Address Fax Number:
402-461-4054
Provider Enumeration Date:
10/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BERGER
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
JOAN
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
402-474-4766

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  219 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 480010032 . This is a "RR MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 470747185 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 47074718513 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 470747195 . This is a "CHAMPUS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 02561 . This is a "BC/BS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 091290 . This is a "MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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