Organization
BLOOMINGTON NORMAL HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS B KULB MD (PHYSICIAN/OWNER)
(309) 834-4000
Entity
Organization
Contact information
Practice address
2100 FORT JESSE RD, NORMAL, IL 61761-9370
(309) 834-4000
(309) 834-4007
Mailing address
2100 FORT JESSE RD, NORMAL, IL 61761-9370
(309) 834-4000
(309) 834-4007
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7002512
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50181
BCBS
IL
Enumeration date
07/19/2005
Last updated
08/22/2020
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