=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073129458
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLOOM GYNECOLOGY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2020
-----------------------------------------------------
Last Update Date | 03/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 HAWKINS RUN RD STE 1
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76065-6670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-900-1040
-----------------------------------------------------
Fax | 682-847-7520
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 HAWKINS RUN RD STE 1
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76065-6670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-900-1040
-----------------------------------------------------
Fax | 682-847-7520
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | SARA CHRISTINE NORTHROP
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 817-542-5912
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------