Healthcare Provider Details

I. General information

NPI: 1356532113
Provider Name (Legal Business Name): BLOOMINGTON SLEEP SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 MCINTYRE DR SUITE 350
BLOOMINGTON IN
47403-4221
US

IV. Provider business mailing address

2920 MCINTYRE DR SUITE 350
BLOOMINGTON IN
47403-4221
US

V. Phone/Fax

Practice location:
  • Phone: 812-332-7337
  • Fax: 812-339-2934
Mailing address:
  • Phone: 812-332-7337
  • Fax: 812-339-2934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE C MCBRIDE
Title or Position: PRACTICE MANAGER
Credential: M.D.
Phone: 812-332-7337