BLOOMINGTON ASC LLC NPI 1356764484

NPI Information

NPI: 1356764484
Provider Name: BLOOMINGTON ASC, LLC

Doing Business As: INDIANA SPECIALTY SURGERY CENTER

Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
1380 W ARCH HAVEN AVE
BLOOMINGTON, IN
ZIP 47403
Phone: (812) 330-1164
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BLOOMINGTON ASC, LLC is an ambulatory surgical clinic center in Bloomington, IN. BLOOMINGTON ASC, LLC NPI is 1356764484. The provider is registered as an organization entity type.
The provider Is Doing Business As Indiana Specialty Surgery Center.

The provider's business location address is:

1380 W ARCH HAVEN AVE
BLOOMINGTON, IN
ZIP 47403-055
Phone: (812) 330-1164
Fax: (812) 332-5102

The provider's authorized official is Jenetha D Moran .
The authorized official title is Officer/authorized Official and has the following contact phone number (972) 763-3893.

The enumeration date for this NPI number is 1/24/2014 and was last updated on 6/30/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	14-011996-1	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	IN1969	MEDICARE PIN	INDIANA
2	15C0001169	MEDICARE OSCAR/CERTIFICATION	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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