Organization
DR PAUL A BERGHUIS INC PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAR MELDAHL (BILLING AGENT)
(360) 466-2542
Entity
Organization
Contact information
Practice address
1401 S LAVENTURE RD, MOUNT VERNON, WA 98274-6033
(360) 336-6517
Mailing address
PO BOX 104, MOUNT VERNON, WA 98273-0104
(360) 336-6517
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
OP00001383
WA
207LP2900X
Pain Medicine (Anesthesiology) Physician
OP00001383
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0226265
DEPARTMENT OF LABOR AND INDUSTRIES
WA
05
—
1124635
—
WA
01
—
2655BE
REGENCE BLUE SHIELD
WA
Enumeration date
10/05/2007
Last updated
05/22/2008
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