Provider Demographics
NPI:1417980715
Name:BERKSHIRE SURGICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:BERKSHIRE SURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-445-6420
Mailing Address - Street 1:777 NORTH ST
Mailing Address - Street 2:PO.BOX 1677
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01202-1677
Mailing Address - Country:US
Mailing Address - Phone:413-445-6420
Mailing Address - Fax:413-499-4907
Practice Address - Street 1:777 NORTH ST
Practice Address - Street 2:SUITE 407
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4147
Practice Address - Country:US
Practice Address - Phone:413-445-6420
Practice Address - Fax:413-499-4907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9787038Medicaid
MA9787038Medicaid