| Mary F. Bergum, Md | |
|
3154 E 29th Ave Spokane WA 99223-4852 | |
| (509) 448-4870 | |
| (800) 976-4305 |
| Full Name | Mary F. Bergum, Md |
|---|---|
| Speciality | Family Medicine |
| Location | 3154 E 29th Ave, Spokane, Washington |
| Authorized Official Name and Position | Mary F. Bergum (OWNER) |
| Authorized Official Contact | 5094484870 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary F. Bergum, Md 3154 E 29th Ave Spokane WA 99223-4852 Ph: (509) 448-4870 | Mary F. Bergum, Md 3154 E 29th Ave Spokane WA 99223-4852 Ph: (509) 448-4870 |
| NPI Number | 1063625150 |
|---|---|
| Provider Enumeration Date | 05/07/2007 |
| Last Update Date | 03/19/2020 |
| Medicare PECOS PAC ID | 0941308977 |
|---|---|
| Medicare Enrollment ID | O20070614000259 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063625150 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD00042807 (Washington) | Primary |
| Provider Name | Mary F Bergum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710053665 PECOS PAC ID: 2365419694 Enrollment ID: I20040915000475 |
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