Provider Demographics
NPI:1023115045
Name:JAMES D BERTUS MD PC
Entity type:Organization
Organization Name:JAMES D BERTUS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:BERTUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-644-7132
Mailing Address - Street 1:PO BOX 5126
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5126
Mailing Address - Country:US
Mailing Address - Phone:605-335-1952
Mailing Address - Fax:605-373-9971
Practice Address - Street 1:301 N 27TH ST STE 10
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4457
Practice Address - Country:US
Practice Address - Phone:402-644-7132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025278400Medicaid
NEDD8426Medicare ID - Type UnspecifiedRAILROAD (GROUP)
NE10025278400Medicaid
NE099756Medicare ID - Type UnspecifiedGROUP