Provider Demographics
NPI:1326020116
Name:BERGH, PATRICIA L (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:BERGH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 MEDICAL PKWY
Mailing Address - Street 2:SUITE 570
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1019
Mailing Address - Country:US
Mailing Address - Phone:512-454-2454
Mailing Address - Fax:512-454-1532
Practice Address - Street 1:3705 MEDICAL PKWY
Practice Address - Street 2:SUITE 570
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1019
Practice Address - Country:US
Practice Address - Phone:512-454-2454
Practice Address - Fax:512-454-1532
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54613367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2771569-008OtherTRICARE
TX82768UOtherBC/BS
TXP01803300OtherRAIL ROAD MEDICARE
TX156417106Medicaid
TX527340YN3XOtherMEDICARE
TX8GX972OtherBCBS
TX156417105Medicaid
TXP01877265OtherMEDICARE RAIL ROAD
TX156417101Medicaid
TX527340YQ8AMedicare PIN
TXP01877265OtherMEDICARE RAIL ROAD
TX8A4575Medicare PIN