Provider Demographics
NPI:1922354539
Name:BERGER, WADE SCOTT (MBA, CCP, SA-C)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:SCOTT
Last Name:BERGER
Suffix:
Gender:M
Credentials:MBA, CCP, SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 WOODMEN DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4278
Mailing Address - Country:US
Mailing Address - Phone:979-743-0508
Mailing Address - Fax:
Practice Address - Street 1:2203 WOODMEN DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4278
Practice Address - Country:US
Practice Address - Phone:979-743-0508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15593246ZC0007X
TXFPF00001162242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant