Organization
BLOOMINGTON MEDICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE M TATE (CREDENTIALING)
(330) 263-8763
Entity
Organization
Contact information
Practice address
1761 BEALL AVE, WOOSTER, OH 44691-2342
(330) 263-8428
(330) 263-8190
Mailing address
1761 BEALL AVE, WOOSTER, OH 44691-2342
(330) 263-8428
(330) 263-8190
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35077131
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2836560
—
OH
Enumeration date
01/31/2008
Last updated
02/05/2015
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