Provider Demographics
NPI:1336138544
Name:BOLINGER, JOHN A (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:BOLINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6898 N COUNTY ROAD 375 W
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-7262
Mailing Address - Country:US
Mailing Address - Phone:812-448-1701
Mailing Address - Fax:
Practice Address - Street 1:1606 N 7TH STREET
Practice Address - Street 2:UNION HOSPITAL
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-2780
Practice Address - Country:US
Practice Address - Phone:812-238-4644
Practice Address - Fax:812-238-7837
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001231A207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100252570Medicaid
IN549210PPPPMedicare PIN
IN100252570Medicaid
INE16351Medicare UPIN
INM400070267Medicare PIN
IN221780BMedicare ID - Type Unspecified