Provider Demographics
NPI:1124991443
Name:BLOOM PEDIATRICS WALK IN CLINIC LLC
Entity type:Organization
Organization Name:BLOOM PEDIATRICS WALK IN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KARASCH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:808-721-0179
Mailing Address - Street 1:5529 ARDEN MILL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-6977
Mailing Address - Country:US
Mailing Address - Phone:808-721-0179
Mailing Address - Fax:
Practice Address - Street 1:5529 ARDEN MILL DR STE 101
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-6977
Practice Address - Country:US
Practice Address - Phone:808-721-0179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty