Provider Demographics
NPI:1578736518
Name:BRYANT A. BLOSS M.D. ORTHOPAEDICS
Entity Type:Organization
Organization Name:BRYANT A. BLOSS M.D. ORTHOPAEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BLOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-479-8571
Mailing Address - Street 1:4770 COVERT AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-5617
Mailing Address - Country:US
Mailing Address - Phone:812-479-8571
Mailing Address - Fax:812-474-6237
Practice Address - Street 1:4770 COVERT AVE
Practice Address - Street 2:STE 104
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-5617
Practice Address - Country:US
Practice Address - Phone:812-479-8571
Practice Address - Fax:812-474-6237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01020011332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90006396Medicaid
IN0762530001Medicare NSC