Healthcare Provider Details

I. General information

NPI: 1093990541
Provider Name (Legal Business Name): ANESTHESIA CARE OF BLOOMINGTON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 S MONROE MEDICAL PARK BLVD
BLOOMINGTON IN
47403-8000
US

IV. Provider business mailing address

PO BOX 10483
BIRMINGHAM AL
35202-0483
US

V. Phone/Fax

Practice location:
  • Phone: 812-825-1111
  • Fax:
Mailing address:
  • Phone: 205-322-1808
  • Fax: 205-322-1851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN D HILLARD
Title or Position: CFO
Credential:
Phone: 336-899-1412