Healthcare Provider Details

I. General information

NPI: 1558314260
Provider Name (Legal Business Name): UNITY PHYSICIAN GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 W 3RD ST
BLOOMINGTON IN
47404-5016
US

IV. Provider business mailing address

PO BOX 4777
BLOOMINGTON IN
47402-4777
US

V. Phone/Fax

Practice location:
  • Phone: 812-336-1690
  • Fax: 812-349-1311
Mailing address:
  • Phone: 812-336-1690
  • Fax: 812-349-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateIN

VIII. Authorized Official

Name: DR. MICHAEL D BISHOP
Title or Position: CEO
Credential:
Phone: 812-336-1690