Provider Demographics
NPI:1457005084
Name:INTERVENTIONAL ORTHOPEDIC SOLUTIONS-ROCHESTER, PLLC
Entity Type:Organization
Organization Name:INTERVENTIONAL ORTHOPEDIC SOLUTIONS-ROCHESTER, PLLC
Other - Org Name:INTERVENTIONAL ORTHOPEDIC SOLUTIONS - ROCHESTER, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERGUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:507-251-5870
Mailing Address - Street 1:5287 SCENIC VIEW DR SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902
Mailing Address - Country:US
Mailing Address - Phone:507-721-9758
Mailing Address - Fax:866-371-6710
Practice Address - Street 1:2560 2ND ST SW
Practice Address - Street 2:SUITE 120
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-4432
Practice Address - Country:US
Practice Address - Phone:507-361-0400
Practice Address - Fax:866-371-6710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty