BLOOMINGTON ORAL & MAXILLOFACIAL SURGERY GROUP (NPI# 1386762318) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386762318 |
| Entity Type | Organization |
| Organization Name | BLOOMINGTON ORAL & MAXILLOFACIAL SURGERY GROUP |
| Practice Address |
637 S Walker Street Suite 1 Bloomington IN 47403-2154 |
| Practice Telephone | 8123239700 |
| Practice Fax Number | 8123239701 |
| Mailing Telephone | 8123239700 |
| Mailing Fax Number | 8123239701 |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. SCOTT E TATE (DOCTOR PRESIDENT) |
| Authorized Official Telephone | 8123239700 |
| Authorized Official Credential | DDS MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 204E00000X | Oral & Maxillofacial Surgery | IN12010196A | IN | Allopathic & Osteopathic Physicians |
| Street Address |
637 S WALKER STREET SUITE 1 |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47403-2154 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043783673 | Brook Whitaker | Registered Nurse | 4011 S. Monroe Medical Park Blvd, Bloomington, IN 47403 | 2019-01-07 |
| 1598251175 | Jacob Edward Lundorf | Nurse Practitioner | 2100 S Liberty Dr Ste B, Bloomington, IN 47403 | 2018-07-06 |
| 1568973717 | Gregory Thomas Dougan | Physician Assistant | 418 South Landmark Avenue, Bloomington, IN 47403 | 2017-10-16 |
| 1295276160 | Indiana Center for Recovery, LLC | Substance Abuse Rehabilitation Facility | 1004 W 1st Street, Bloomington, IN 47403 | 2017-03-13 |
| 1144694217 | Kayla Dewolf | Specialist/Technologist | 1471 W Allen St, Bloomington, IN 47403 | 2015-11-30 |
| 1164806444 | Monroe Hosoital | General Acute Care Hospital | 4011 Monroe Medical Park, Bloomington, IN 47403 | 2015-07-16 |
| 1821411588 | Jennifer Turner | Occupational Therapy Assistant | 1023 West Main St, Swiss Villa, Vevay, IN 47403 | 2014-01-30 |
| 1104170232 | Kendall Basore | Social Worker | 445 S. Landmark Ave., Bloomington, IN 47403 | 2012-10-26 |
| 1568715886 | Indiana Hearing LLC | Hearing Aid Equipment | 2019 S Liberty Dr, Bloomington, IN 47403 | 2012-10-24 |
| 1679870232 | Accurate Hearing Services | Clinic/Center | 1355 W Second St, #3, Bloomington, IN 47403 | 2011-02-17 |
| Find all providers in zip 47403 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295041093 | Central Indiana Oral Surgery and Implantology | Oral & Maxillofacial Surgery | 272 Medical Dr., Carmel, IN 46032 | 2010-08-31 |
| 1083757355 | Carrie A. Klene | Oral & Maxillofacial Surgery | 715 W Carmel Dr Ste 102, Carmel, IN 46032-5881 | 2007-02-15 |
| 1689743809 | Rodney P Swantko | Oral & Maxillofacial Surgery | 9250 Columbia Avenue, Suite D 1, Munster, IN 46321 | 2006-11-06 |
| 1114007838 | Micheal J Deady Dds Inc | Oral & Maxillofacial Surgery | 1630 Poplar St, Terre Haute, IN 47807 | 2006-10-17 |
| 1134213796 | Tristan Vaun Stonger | Oral & Maxillofacial Surgery | 1 S Broadway, Peru, IN 46970-2231 | 2006-10-03 |
| 1558789891 | William Gardner Moll | Oral & Maxillofacial Surgery | 601 W Us Highway 30, Schererville, IN 46375-2656 | 2014-04-03 |
| 1205998739 | John Craig Cook | Oral & Maxillofacial Surgery | 1919 State St, Ste 407, New Albany, IN 47150 | 2006-12-14 |
| 1831264324 | Oral & Maxillofacial Surgery Associates PC | Oral & Maxillofacial Surgery | 7845 Carnegie Blvd, Fort Wayne, IN 46804 | 2006-11-21 |
| 1366512972 | Michael Joseph Deady | Oral & Maxillofacial Surgery | 1630 Poplar St, Terre Haute, IN 47807 | 2006-11-09 |
| 1588733703 | Munster Oral Surgery Inc | Oral & Maxillofacial Surgery | 9250 Columbia Avenue, Suite D 1, Munster, IN 46321 | 2006-11-06 |
| Find all providers with the same taxonomy | ||||
| City | BLOOMINGTON |
| Zip Code | 47403 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.