Organization
BERTRAND DIAGNOSTIC IMAGING AND BREAST CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. EILEEN KANEWSKE (DIRECTOR PT. ACCOUNTS)
(512) 340-8114
Entity
Organization
Contact information
Practice address
1126 N CHURCH ST, SUITE 103, GREENSBORO, NC 27401-1000
(336) 379-0941
(336) 379-7997
Mailing address
PO BOX 6730565, DALLAS, TX 75373-0001
(866) 613-5807
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
20236
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0270A
BLUE CROSS PROVIDER NUMBE
NC
05
—
890270A
—
NC
Enumeration date
11/02/2005
Last updated
05/15/2008
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