Provider Demographics
NPI:1225087059
Name:BERNER ER SERVICES PARTNERSHIP
Entity Type:Organization
Organization Name:BERNER ER SERVICES PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:GATEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-362-2731
Mailing Address - Street 1:PO BOX 13068
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3068
Mailing Address - Country:US
Mailing Address - Phone:800-355-3818
Mailing Address - Fax:
Practice Address - Street 1:500 W SUGARLAND HWY
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3021
Practice Address - Country:US
Practice Address - Phone:863-983-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276705800Medicaid
FL72620OtherBLUE SHIELD
FL276705800Medicaid
FLAC252Medicare PIN