Organization
BLOOMINGTON MEDICAL LABORATORY PHYSICIANS, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY JOYCE M.D. (PRESIDENT)
(800) 288-8325
Entity
Organization
Contact information
Practice address
2200 E WASHINGTON ST, BLOOMINGTON, IL 61701-4364
(309) 663-2237
Mailing address
PO BOX 9518, PEORIA, IL 61612-9518
(309) 663-2237
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05719553
BLUE CROSS BLUE SHIELD
IL
01
—
CC1703
RAILROAD MEDICARE
IL
Enumeration date
07/02/2006
Last updated
08/03/2020
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