Provider Demographics
NPI:1942432406
Name:BERTROCHE & ASSOCIATES
Entity Type:Organization
Organization Name:BERTROCHE & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BERTROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-334-9484
Mailing Address - Street 1:5525 MEREDITH DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-2334
Mailing Address - Country:US
Mailing Address - Phone:515-334-9484
Mailing Address - Fax:515-334-9498
Practice Address - Street 1:5525 MEREDITH DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-2334
Practice Address - Country:US
Practice Address - Phone:515-334-9484
Practice Address - Fax:515-334-9498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA032202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2215616Medicaid