Provider Demographics
NPI:1376911545
Name:BERG & MINIGUTTI, PLLC
Entity Type:Organization
Organization Name:BERG & MINIGUTTI, PLLC
Other - Org Name:WEST FRISCO HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TEER
Authorized Official - Suffix:
Authorized Official - Credentials:NRCMA
Authorized Official - Phone:972-464-2510
Mailing Address - Street 1:4280 MAIN ST
Mailing Address - Street 2:STE 200
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-3080
Mailing Address - Country:US
Mailing Address - Phone:972-464-2510
Mailing Address - Fax:214-705-1379
Practice Address - Street 1:4280 MAIN ST
Practice Address - Street 2:STE 200
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-3080
Practice Address - Country:US
Practice Address - Phone:972-464-2510
Practice Address - Fax:214-705-1379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3756207Q00000X
TXN0643207R00000X
261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX473738Medicare PIN