Healthcare Provider Details

I. General information

NPI: 1033298120
Provider Name (Legal Business Name): BLOOMINGTON MEADOWS GP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 N PROW RD
BLOOMINGTON IN
47404-1616
US

IV. Provider business mailing address

3600 N PROW RD
BLOOMINGTON IN
47404-1616
US

V. Phone/Fax

Practice location:
  • Phone: 812-331-8000
  • Fax: 812-331-8985
Mailing address:
  • Phone: 812-331-8000
  • Fax: 812-331-8985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0813X
TaxonomyGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number324-1-PIP
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number324-1-PIP
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number28152858A
License Number StateIN
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000894A
License Number StateIN

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: SR VP CFO
Credential:
Phone: 610-768-3300