Berg, Mary Ellen
Berg, Mary Ellen is an individual health care provider with primary practice located at 471 Ashley Ridge Blvd , Shreveport LA 71106. She recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as her primary health care specialty. Berg, Mary Ellen can be contacted via phone (318) 795-4770.Contact Information
Primary practice address
471 Ashley Ridge Blvd
Shreveport LA 71106
Phone: (318) 795-4770
Fax: (318) 795-4775
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 019001 | Louisiana |
Profile Details
| NPI number | 1174524391 |
|---|---|
| LBN Legal business name | Berg, Mary Ellen |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 10th, 2005 |
| Last updated | Dec 11th, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174524391 | NPPES |
| Arkansas | Other | 123802001 | ARKANSAS MEDICAID |
| Arkansas | Other | 1053315846 | ARKANSAS MEDICAID |
| Arkansas | MEDICAID | 1922871 | ARKANSAS MEDICAID |
| Arkansas | Other | 078737601 | ARKANSAS MEDICAID |
| Arkansas | Other | P00375906 | ARKANSAS MEDICAID |
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