Vincent Anthony Bergamo

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

25881 Issued in TN

Practice address

1861 Main St
Sneedville, TN 37869-3645

Phone

(423) 733-2131

Fax

(423) 733-1055

NPI assigned

Mar 9, 2020

Last updated

Mar 9, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583712000000",
    "number": "1003441239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850",
            "city": "ROGERSVILLE",
            "state": "TN",
            "postal_code": "378570850",
            "telephone_number": "423-272-9163",
            "fax_number": "423-921-6920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1861 MAIN ST",
            "city": "SNEEDVILLE",
            "state": "TN",
            "postal_code": "378693645",
            "telephone_number": "423-733-2131",
            "fax_number": "423-733-1055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGAMO",
        "first_name": "VINCENT",
        "middle_name": "ANTHONY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-09",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "25881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Sneedville, TN
• Providers in Sneedville, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.