=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730003856
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INDIANA UNIVERSITY HEALTH BLOOMINGTON INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2026
-----------------------------------------------------
Last Update Date | 08/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5921 W STATE ROAD 46
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47404-9359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-935-8866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5921 W STATE ROAD 46
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47404-9359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP/CFO
-----------------------------------------------------
Name | MICHAEL L CRAIG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 812-353-9171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------