Healthcare Provider Details

I. General information

NPI: 1073129458
Provider Name (Legal Business Name): BLOOM GYNECOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HIGHLANDER AVE STE 300
MIDLOTHIAN TX
76065-3515
US

IV. Provider business mailing address

800 HIGHLANDER AVE STE 300
MIDLOTHIAN TX
76065-3515
US

V. Phone/Fax

Practice location:
  • Phone: 682-900-1040
  • Fax: 682-847-7520
Mailing address:
  • Phone: 682-900-1040
  • Fax: 682-847-7520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARA CHRISTINE NORTHROP
Title or Position: DOCTOR
Credential: DO
Phone: 817-542-5912