Provider Demographics
NPI:1033298120
Name:BLOOMINGTON MEADOWS GP
Entity Type:Organization
Organization Name:BLOOMINGTON MEADOWS GP
Other - Org Name:BLOOMINGTON MEADOWS PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:SR VP CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:3600 N PROW RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-1616
Mailing Address - Country:US
Mailing Address - Phone:812-331-8000
Mailing Address - Fax:812-331-8985
Practice Address - Street 1:3600 N PROW RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-1616
Practice Address - Country:US
Practice Address - Phone:812-331-8000
Practice Address - Fax:812-331-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN324-1-PIP2084P0800X, 283Q00000X
IN71000894A363LF0000X
IN28152858A363LP0200X
364SP0807X, 364SP0813X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No283Q00000XHospitalsPsychiatric HospitalGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & AdolescentGroup - Multi-Specialty
No364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, GeropsychiatricGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN060128000OtherMAGELLAN
IN107936OtherANTHEM
IN200075480Medicaid
OH2398043OtherOHIO MEDICAID
OH2398043OtherOHIO MEDICAID
IN200075480Medicaid