Healthcare Provider Details

I. General information

NPI: 1922640077
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH BLOOMINGTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 E DISCOVERY PKWY STE A2032
BLOOMINGTON IN
47408-9059
US

IV. Provider business mailing address

390 AIRTECH PKWY STE 106
PLAINFIELD IN
46168-7456
US

V. Phone/Fax

Practice location:
  • Phone: 812-353-9860
  • Fax: 812-353-9335
Mailing address:
  • Phone: 317-963-9730
  • Fax: 317-963-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL L CRAIG
Title or Position: CFO
Credential:
Phone: 812-353-5819