Provider Demographics
NPI:1215965611
Name:DEGEN-BERGLUND, INC
Entity type:Organization
Organization Name:DEGEN-BERGLUND, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RECKASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-775-8500
Mailing Address - Street 1:PO BOX 3157
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54602-3157
Mailing Address - Country:US
Mailing Address - Phone:608-775-8500
Mailing Address - Fax:608-775-8555
Practice Address - Street 1:2441 GREEN BAY ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:608-775-8571
Practice Address - Fax:608-775-8578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X
WI8773-0423336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5106489OtherNCPDP
IA0516526Medicaid
WI33236300Medicaid
WIFD0491934OtherDEA
IA0516526Medicaid