Organization
THE CENTER FOR ORTHOPEDIC MEDICINE, LLC
Active
Other names
The Center for Outpatient Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SARAH ELLEN GARDNER (BUSINESS DIRECTOR)
(309) 662-6120
Entity
Organization
Contact information
Practice address
2502 B. EAST EMPIRE STREET, BLOOMINGTON, IL 61704
(309) 662-6120
(309) 661-0060
Mailing address
2502 B. EAST EMPIRE STREET, BLOOMINGTON, IL 61704
(309) 662-6120
(309) 661-0060
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7002116
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001937
HEALTH ALLIANCE
IL
01
—
00214363001
UNITED HEALTHCARE
IL
01
—
490003202
RR MEDICARE
IL
01
—
551
BLUE CROSS BLUE SHEILD
IL
Enumeration date
07/04/2006
Last updated
09/11/2020
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