Provider Demographics
NPI:1811091390
Name:BLOOMFIELD ANESTHETISTS
Entity type:Organization
Organization Name:BLOOMFIELD ANESTHETISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-664-3602
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537-0054
Mailing Address - Country:US
Mailing Address - Phone:641-664-3602
Mailing Address - Fax:641-664-3765
Practice Address - Street 1:105 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IA
Practice Address - Zip Code:52537-0054
Practice Address - Country:US
Practice Address - Phone:641-664-3602
Practice Address - Fax:641-664-3765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA26643OtherBCBS OF IOWA
IA0266437Medicaid
IA0266437Medicaid