Provider Demographics
NPI:1477840254
Name:BERG DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:BERG DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WYRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-378-7646
Mailing Address - Street 1:7672 AVIANCA DR # C-50
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-9713
Mailing Address - Country:US
Mailing Address - Phone:530-378-7646
Mailing Address - Fax:530-243-8973
Practice Address - Street 1:12 MICHIGAN DR
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1339
Practice Address - Country:US
Practice Address - Phone:617-588-2170
Practice Address - Fax:615-872-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory