Basic Information
| Provider Information | |||||||||
| NPI: | 1801443387 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERKBIGLER ORTHOPAEDICS AND SPORTS SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 606 MAPLE VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636401976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737567779 | ||||||||
| FaxNumber: | 8888499365 | ||||||||
| Practice Location | |||||||||
| Address1: | 606 MAPLE VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636401976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737567779 | ||||||||
| FaxNumber: | 8888493965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2019 | ||||||||
| LastUpdateDate: | 01/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | PIERCE | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTIACE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5737567779 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200005304 | 05 | MO | MEDICAID |