Individual
CAROL J BERGBOWER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1000 N ALLEN ST, ROBINSON, IL 62454-1114
(618) 544-3131
(618) 546-2614
Mailing address
1000 N ALLEN ST, ROBINSON, IL 62454-1114
(618) 544-3131
(618) 546-2614
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
041212985
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01732004
BC/BS
IL
01
—
020354300
BLACK LUNG
IL
01
—
041212985
STATE LICENSE
IL
01
—
200009980
IRS TAX ID
IL
01
—
540347
HEALTHLINK
IL
01
—
DA2630
RR MEDICARE GROUP
IL
01
—
P00042146
RR MEDICARE PIN
IL
Enumeration date
06/09/2006
Last updated
10/29/2020
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us