Provider Demographics
NPI:1043373095
Name:BYNUM SURGICAL APPLIANCES, INC.
Entity Type:Organization
Organization Name:BYNUM SURGICAL APPLIANCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ORTHOSIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BYNUM
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:812-333-0518
Mailing Address - Street 1:PO BOX 5963
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47407-5963
Mailing Address - Country:US
Mailing Address - Phone:812-333-0518
Mailing Address - Fax:812-323-3174
Practice Address - Street 1:700 S COLLEGE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2500
Practice Address - Country:US
Practice Address - Phone:812-333-0518
Practice Address - Fax:812-323-3174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0356930001Medicare ID - Type Unspecified