Provider Demographics
NPI:1326375346
Name:BLOOMINGTON PERFUSIONIST INC.
Entity Type:Organization
Organization Name:BLOOMINGTON PERFUSIONIST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:CCP
Authorized Official - Phone:309-830-6663
Mailing Address - Street 1:1419 TAMARACK CC TRL
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-5265
Mailing Address - Country:US
Mailing Address - Phone:309-830-6663
Mailing Address - Fax:309-454-9292
Practice Address - Street 1:2005 JACOBSSEN DR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-6279
Practice Address - Country:US
Practice Address - Phone:309-888-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL28914899332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies