Organization
BLOOMINGTON ENDOSCOPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL CRAIG (CFO)
(812) 353-9554
Entity
Organization
Contact information
Practice address
550 S LANDMARK AVE, BLOOMINGTON, IN 47403-3239
(812) 331-3650
(812) 355-6925
Mailing address
550 S LANDMARK AVE, BLOOMINGTON, IN 47403-3239
(812) 331-3650
(812) 355-6925
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
05-002674-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200319120
—
IN
Enumeration date
06/16/2005
Last updated
12/07/2018
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