Healthcare Provider Details

I. General information

NPI: 1063713154
Provider Name (Legal Business Name): FUTURES FAMILY PLANNING CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 S WALNUT ST
BLOOMINGTON IN
47401-3500
US

IV. Provider business mailing address

338 S WALNUT ST
BLOOMINGTON IN
47401-3500
US

V. Phone/Fax

Practice location:
  • Phone: 812-349-7343
  • Fax: 812-349-7346
Mailing address:
  • Phone: 812-349-7343
  • Fax: 812-349-7346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number71000194A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License NumberMSO232354
License Number StateIN

VIII. Authorized Official

Name: DR. THOMAS SHARP
Title or Position: HEALTH OFFICER MONROE CO. HEALTH D.
Credential: M.D.
Phone: 812-349-2068