Basic Information
| Provider Information | |||||||||
| NPI: | 1396284410 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLOOMINGTON EMERGENCY CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4011 S MONROE MEDICAL PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474038000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128251111 | ||||||||
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| Address1: | 4011 S MONROE MEDICAL PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474038000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128251111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2017 | ||||||||
| LastUpdateDate: | 02/22/2017 | ||||||||
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| AuthorizedOfficialLastName: | O'BRIEN | ||||||||
| AuthorizedOfficialFirstName: | ERIKA | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO-CFO | ||||||||
| AuthorizedOfficialTelephone: | 7654460170 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | IN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.