Provider Demographics
NPI:1922737923
Name:BLOOM PEDIATRIC PARTNERS, PLLC
Entity Type:Organization
Organization Name:BLOOM PEDIATRIC PARTNERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BEAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:706-340-3138
Mailing Address - Street 1:612 NORTH BROAD STREET EAST
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-8954
Mailing Address - Country:US
Mailing Address - Phone:706-340-3138
Mailing Address - Fax:877-485-3477
Practice Address - Street 1:612 NORTH BROAD STREET EAST
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-8954
Practice Address - Country:US
Practice Address - Phone:706-340-3138
Practice Address - Fax:877-485-3477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center