1578736518 NPI number — BRYANT A. BLOSS M.D. ORTHOPAEDICS

Table of content: (NPI 1578736518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578736518 NPI number — BRYANT A. BLOSS M.D. ORTHOPAEDICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRYANT A. BLOSS M.D. ORTHOPAEDICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578736518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4770 COVERT AVE
Provider Second Line Business Mailing Address:
STE 104
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47714-5617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-479-8571
Provider Business Mailing Address Fax Number:
812-474-6237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4770 COVERT AVE
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47714-5617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-479-8571
Provider Business Practice Location Address Fax Number:
812-474-6237
Provider Enumeration Date:
04/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BLOSS
Authorized Official First Name:
BRYANT
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
812-479-8571

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  01020011 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 90006396 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com