PROACTIVE MSO LLC NPI 1275371080

NPI Information

  • NPI: 1275371080
  • Provider Name: PROACTIVE MSO, LLC
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • Address: 501 N MORTON ST STE 109
    BLOOMINGTON, IN
    ZIP 47404
  • Phone: (864) 501-0751

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NPI Details

PROACTIVE MSO, LLC is a primary care clinic center in Bloomington, IN. PROACTIVE MSO, LLC NPI is 1275371080. The provider is registered as an organization entity type.

The provider's business location address is:

501 N MORTON ST STE 109
BLOOMINGTON, IN
ZIP 47404-732
Phone: (864) 501-0751
Fax: (864) 990-3834

The provider's authorized official is Jody B Addair .
The authorized official title is Clinical Ops Project Coordinator and has the following contact phone number (317) 556-0017.

The enumeration date for this NPI number is 7/16/2024 and was last updated on 9/23/2025.

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
1261QP2300XClinic/CenterPrimary CareYes

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: 11/21/2025

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