1376083642 NPI number — WORKPLACE HEALTH SERVICES, LLC

Table of content: ROBIN JEAN BERGBAUER MD (NPI 1972633139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376083642 NPI number — WORKPLACE HEALTH SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WORKPLACE HEALTH SERVICES, LLC
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:
6
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:
1376083642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 N MERIDIAN ST
Provider Second Line Business Mailing Address:
STE 950
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46204-1077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-963-1616
Provider Business Mailing Address Fax Number:
317-963-1621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 N BOEKE RD
Provider Second Line Business Practice Location Address:
DOOR 23
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47711-5925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-773-3043
Provider Business Practice Location Address Fax Number:
812-773-3023
Provider Enumeration Date:
03/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DARROCA
Authorized Official First Name:
GERALDINE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
317-963-1618

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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