Provider Demographics
NPI:1750313250
Name:SURGICAL ASSOCIATES OF BLOOMINGTON, PC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF BLOOMINGTON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-336-4707
Mailing Address - Street 1:822 W 1ST ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2384
Mailing Address - Country:US
Mailing Address - Phone:812-336-4707
Mailing Address - Fax:812-334-1093
Practice Address - Street 1:822 W 1ST ST
Practice Address - Street 2:SUITE 8
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2384
Practice Address - Country:US
Practice Address - Phone:812-336-4707
Practice Address - Fax:812-334-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDF0586OtherTRAVELERS MEDICARE