NPIMap

Organization Active NPI

Bloomington Oral & Maxillofacial Surgery

Doing business as Martinsville Oral & Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Martinsville, IN
National Provider Identifier
1619268265
Registry record updated Apr 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
12010196 Issued in IN
Legal business name
BLOOMINGTON ORAL & MAXILLOFACIAL SURGERY
Doing business as
Martinsville Oral & Maxillofacial Surgery
Practice address
509 State Road 39 Byp S
Martinsville, IN 46151-1972
Phone
(765) 352-9700
Fax
(765) 352-9701
NPI assigned
Apr 29, 2011
Last updated
Apr 29, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2011

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

Authorized official

Name
Dr. Scott E Tate, DDS, MSNPI 1528166097
Title
Owner
Phone
(812) 323-9700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 12010196 IN Primary

Addresses

Primary practice location

509 State Road 39 Byp S
Martinsville, IN 46151-1972

Mailing address

509 State Road 39 Byp S
Martinsville, IN 46151-1972
Phone (765) 352-9700

Other identifiers 1

IdentifierTypeStateIssuer
200448260MedicaidIN

Other names 1

  • Martinsville Oral & Maxillofacial Surgery Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bloomington Oral Maxillofacial Surgery2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1304035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304035200000",
    "number": "1619268265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 STATE ROAD 39 BYP S",
            "city": "MARTINSVILLE",
            "state": "IN",
            "postal_code": "461511972",
            "telephone_number": "765-352-9700",
            "fax_number": "765-352-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 STATE ROAD 39 BYP S",
            "city": "MARTINSVILLE",
            "state": "IN",
            "postal_code": "461511972",
            "telephone_number": "765-352-9700",
            "fax_number": "765-352-9701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON ORAL & MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-29",
        "last_updated": "2011-04-29",
        "status": "A",
        "authorized_official_last_name": "TATE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-323-9700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12010196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200448260",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Martinsville Oral & Maxillofacial Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Martinsville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2011; 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.