Provider Demographics
NPI:1558423806
Name:BLOOMINGTON CARDIOLOGY PC
Entity Type:Organization
Organization Name:BLOOMINGTON CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CALLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:812-333-4327
Mailing Address - Street 1:822 W 1ST ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403
Mailing Address - Country:US
Mailing Address - Phone:812-333-4327
Mailing Address - Fax:812-961-1521
Practice Address - Street 1:822 W 1ST ST
Practice Address - Street 2:SUITE 7
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403
Practice Address - Country:US
Practice Address - Phone:812-333-4327
Practice Address - Fax:812-961-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110086318OtherTRAVELERS
IN000000104956OtherANTHEM BC/BS
IN200185840Medicaid
110086318OtherTRAVELERS