Organization
BLOOMINGTON ADVANCED SURGERY CENTER, LLC
Active
Other names
Bloomington Advanced Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
WESLEY G LACKEY MD (MEDICAL DIRECTOR)
(317) 455-1064
Entity
Organization
Contact information
Practice address
445 S LANDMARK AVE, BLOOMINGTON, IN 47403-5004
(708) 275-7799
Mailing address
445 S LANDMARK AVE, BLOOMINGTON, IN 47403-5004
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
08/17/2021
Last updated
08/17/2021
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