Provider Demographics
NPI:1073129458
Name:BLOOM GYNECOLOGY LLC
Entity Type:Organization
Organization Name:BLOOM GYNECOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:NORTHROP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-542-5912
Mailing Address - Street 1:505 CARNATION LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3540 E BROAD ST # 262
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5633
Practice Address - Country:US
Practice Address - Phone:817-542-5912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty