Provider Demographics
NPI:1437104064
Name:DEGEN BERGLUND INC
Entity Type:Organization
Organization Name:DEGEN BERGLUND INC
Other - Org Name:DEGEN BERGLUND SHELBY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:BINGOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-775-8500
Mailing Address - Street 1:4000 MORMON COULEE RD
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7902
Mailing Address - Country:US
Mailing Address - Phone:608-775-8500
Mailing Address - Fax:608-775-8555
Practice Address - Street 1:4000 MORMON COULEE RD
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7902
Practice Address - Country:US
Practice Address - Phone:608-775-8500
Practice Address - Fax:608-775-8555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41704200Medicaid
MN940215200Medicaid
IA0764092Medicaid
MN940215200Medicaid