PROACTIVE MSO LLC NPI 1427569367

NPI Information

NPI: 1427569367
Provider Name: PROACTIVE MSO, LLC

Other Name: PROACTIVE MD

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
524 N FAIRVIEW ST
BLOOMINGTON, IN
ZIP 47404
Phone: (812) 645-1892
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PROACTIVE MSO, LLC is a primary care clinic center in Bloomington, IN. PROACTIVE MSO, LLC NPI is 1427569367. The provider is registered as an organization entity type.
The provider Other Name Is Proactive Md.

The provider's business location address is:

524 N FAIRVIEW ST
BLOOMINGTON, IN
ZIP 47404-774
Phone: (812) 645-1892

The provider's authorized official is Jan Hopkins .
The authorized official title is Assoc. Ops Mgr and has the following contact phone number (864) 501-0751.

The CLIA number assigned to this NPI record is 15D2138522 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/18/2017 and was last updated on 3/25/2022.

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	261QP2300X	Clinic/Center	Primary Care			Yes

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: 4/28/2024

NPI Synchronization or Removal

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