Provider Demographics
NPI:1437703204
Name:BERTAGNOLLI MEDCIATION SERVICES
Entity Type:Organization
Organization Name:BERTAGNOLLI MEDCIATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZATION OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTAGNOLLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:573-821-6418
Mailing Address - Street 1:1008 W 93RD ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-3216
Mailing Address - Country:US
Mailing Address - Phone:573-821-6418
Mailing Address - Fax:
Practice Address - Street 1:1008 W 93RD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3216
Practice Address - Country:US
Practice Address - Phone:573-821-6418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty