Provider Demographics
NPI:1285678904
Name:BLOEM ORTHOPAEDIC CENTER, P.A.
Entity Type:Organization
Organization Name:BLOEM ORTHOPAEDIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHUS
Authorized Official - Middle Name:TH
Authorized Official - Last Name:BLOEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-937-2663
Mailing Address - Street 1:3101 ZEBULON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804
Mailing Address - Country:US
Mailing Address - Phone:252-937-2663
Mailing Address - Fax:252-937-4894
Practice Address - Street 1:3101 ZEBULON RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2426
Practice Address - Country:US
Practice Address - Phone:252-937-2663
Practice Address - Fax:252-937-4894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24225207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890230WMedicaid
C49462Medicare UPIN
NC890230WMedicaid
202577CMedicare PIN