NPIMap

Organization Active NPI

RNL Berwick Im

  • Specialist
  • Conroe, TX
National Provider Identifier
1285996249
Registry record updated Oct 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
E6039 Issued in TX
Legal business name
RNL BERWICK IM
Practice address
690 S Loop 336 W
Suite 3050
Conroe, TX 77304-3318
Phone
(936) 760-7850
Fax
(936) 521-7396
NPI assigned
Jun 14, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2012

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

Authorized official

Name
A Glen Berwick, M.D.
Title
Owner
Phone
(936) 760-7850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X E6039 TX Primary

Addresses

Primary practice location

690 S Loop 336 W
Suite 3050
Conroe, TX 77304-3318

Mailing address

690 S Loop 336 W
Suite 3050
Conroe, TX 77304-3318
Phone (936) 760-7850

Other identifiers 1

IdentifierTypeStateIssuer
1151946-02.MedicaidTX

National Provider Directory

National Provider Directory

Locations

690 S Loop 336 W
Ste 3050
Conroe, TX 77304
Phone (936) 760-7850

690 S Loop 336 W
Ste 3080
Conroe, TX 77304
Phone (936) 760-4600

508 Medical Center Blvd
Ste 237
Conroe, TX 77304

NPI Registry JSON

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

{
    "created_epoch": "1339632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351555200000",
    "number": "1285996249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 S LOOP 336 W",
            "address_2": "SUITE 3050",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043318",
            "telephone_number": "936-760-7850",
            "fax_number": "936-521-7396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 S LOOP 336 W",
            "address_2": "SUITE 3050",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043318",
            "telephone_number": "936-760-7850",
            "fax_number": "936-521-7396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RNL BERWICK IM",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-14",
        "last_updated": "2012-10-30",
        "status": "A",
        "authorized_official_last_name": "BERWICK",
        "authorized_official_first_name": "A",
        "authorized_official_middle_name": "GLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "936-760-7850",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "E6039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1151946-02.",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; 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.