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Contact Information

BLOOMINGTON DERMATOLOGY CLINIC
2001 E 3RD ST
BLOOMINGTON, IN47401-7890
 Phone: 812-333-0398
 Fax: 812-333-0698
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for BLOOMINGTON DERMATOLOGY CLINIC

NPI # 1003914920
LBN Legal business name BLOOMINGTON DERMATOLOGY CLINIC
Authorized official SCOTT WILHELMUS - (C.E.O.)
Entity Organization
Organization subpart 1 No
Enumeration date 09/21/2006
Last updated 05/21/2020 - About 6 years ago
Identifiers
IN License # 01042083A
Other $$$$$$$$$ SOCIAL SECURITY NUMBER
IN Other 000000090314 ANTHEM
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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