Iidsm Bloomington LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

IIDSM BLOOMINGTON LLC

Practice address

2309 E Empire St
500
Bloomington, IL 61704-8636

Phone

(309) 319-6568

NPI assigned

Dec 5, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cailin Spencer

Title

Accounts Receivable Manager

Phone

(309) 243-1341

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337126400000",
    "number": "1366710410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11825 STATE ROUTE 40",
            "address_2": "SUITE 100",
            "city": "DUNLAP",
            "state": "IL",
            "postal_code": "615258842",
            "telephone_number": "309-243-1341",
            "fax_number": "309-240-0351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2309 E EMPIRE ST",
            "address_2": "500",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617048636",
            "telephone_number": "309-319-6568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IIDSM BLOOMINGTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-05",
        "last_updated": "2012-05-16",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "CAILIN",
        "authorized_official_title_or_position": "ACCOUNTS RECEIVABLE MANAGER",
        "authorized_official_telephone_number": "309-243-1341"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.