Organization
EAGLE DANCER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND STIDD DPM (PROVIDER)
(812) 330-0909
Entity
Organization
Contact information
Practice address
414 S COLLEGE AVE, BLOOMINGTON, IN 47403-1513
(812) 331-1962
(812) 332-1949
Mailing address
414 S COLLEGE AVE, BLOOMINGTON, IN 47403-1513
(812) 331-1962
(812) 332-1949
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
280-B
IN
Other
Enumeration date
04/30/2008
Last updated
11/23/2009
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