Healthcare Provider Details

I. General information

NPI: 1922032051
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH BLOOMINGTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 2ND ST
BLOOMINGTON IN
47403-2317
US

IV. Provider business mailing address

601 W 2ND ST
BLOOMINGTON IN
47403-2317
US

V. Phone/Fax

Practice location:
  • Phone: 812-353-5819
  • Fax: 812-353-5228
Mailing address:
  • Phone: 812-353-5819
  • Fax: 812-353-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES J MYERS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 812-353-9551