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General NPI Number Information
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NPI Number | 1053496471
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Entity Type | Organization
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Legal Business Name | BLOOMINGTON RHEUMATOLOGY CENTER LLC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3316 E MULBERRY DR
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City | BLOOMINGTON
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State | IN
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Zip | 47401-2426
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Country | US
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Telephone | 812-330-1558
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Fax |
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Provider Business Mailing Address
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Address Line | 3316 E MULBERRY DR
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City | BLOOMINGTON
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State | IN
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Zip | 47401-2426
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Country | US
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Telephone | 812-330-1558
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM PARKER RUSCHE
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Credential | M.D.
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Telephone | 812-330-1558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 01048956
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License Number State | IN
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