Organization
BLOOMINGTON ENT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSE PHILLIPS MD (OWNER)
(812) 335-1300
Entity
Organization
Contact information
Practice address
1791 W 3RD ST, BLOOMINGTON, IN 47404-5029
(812) 335-1300
(812) 335-0300
Mailing address
1791 W 3RD ST, BLOOMINGTON, IN 47404-5029
(812) 335-1300
(812) 335-0300
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01040385A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000209641
ANTHEM BCBS
IN
01
—
2440326
CIGNA
IA
01
—
546541P
SIHO
IN
01
—
5818093
AETNA
IN
Enumeration date
01/26/2006
Last updated
04/15/2008
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