Healthcare Provider Details

I. General information

NPI: 1538191036
Provider Name (Legal Business Name): BLOOMINGTON BONE & JOINT CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 S WALKER ST SUITE E
BLOOMINGTON IN
47403-2123
US

IV. Provider business mailing address

639 S WALKER ST SUITE E
BLOOMINGTON IN
47403-2123
US

V. Phone/Fax

Practice location:
  • Phone: 812-333-4000
  • Fax: 812-323-3188
Mailing address:
  • Phone: 812-333-4000
  • Fax: 812-323-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY M FOX
Title or Position: PRESIDENT
Credential: M.D.
Phone: 812-333-4000