Provider Demographics
NPI:1891796108
Name:BLOOMINGTON MEADOWS GP
Entity Type:Organization
Organization Name:BLOOMINGTON MEADOWS GP
Other - Org Name:BLOOMINGTON MEADOWS HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SRVP CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:3600 N PROW RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-1616
Mailing Address - Country:US
Mailing Address - Phone:812-331-8000
Mailing Address - Fax:812-331-8056
Practice Address - Street 1:3600 N PROW RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-1616
Practice Address - Country:US
Practice Address - Phone:812-331-8000
Practice Address - Fax:812-331-8056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3241PIP283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100273680Medicaid
IN100273680Medicaid