Provider Demographics
NPI:1184214223
Name:MICAH BERRY M D INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICAH BERRY M D INC A PROFESSIONAL CORPORATION
Other - Org Name:SIERRA NEVADA ORTHOPEDIC INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-777-0011
Mailing Address - Street 1:300 SIERRA COLLEGE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5083
Mailing Address - Country:US
Mailing Address - Phone:530-777-0011
Mailing Address - Fax:
Practice Address - Street 1:280 SIERRA COLLEGE DR STE 210
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5769
Practice Address - Country:US
Practice Address - Phone:530-777-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty