Eagle Dancer Inc

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

280-B Issued in IN

Legal business name

EAGLE DANCER INC

Practice address

414 S College Ave
Bloomington, IN 47403-1513

Phone

(812) 331-1962

Fax

(812) 332-1949

NPI assigned

Apr 30, 2008

Last updated

Nov 23, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Raymond Stidd, DPM

Title

Provider

Phone

(812) 330-0909

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258934400000",
    "number": "1700051711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 S COLLEGE AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474031513",
            "telephone_number": "812-331-1962",
            "fax_number": "812-332-1949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 S COLLEGE AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474031513",
            "telephone_number": "812-331-1962",
            "fax_number": "812-332-1949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE DANCER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-30",
        "last_updated": "2009-11-23",
        "status": "A",
        "authorized_official_last_name": "STIDD",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "812-330-0909",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "IN",
            "license": "280-B",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Luke Eades, DDS
• Katherine Eads
• Samantha Eads, FNP
• Samantha Anne Eads, RN
• Todd A Eads, M.D.
• Sarah Earhart
• Kamiyah Earley
• William Wade Earls, M.A.
• Eartheart LLC
• Bret Davis Eartheart, MSW, LCSW

• Customized Equipment (DME) in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Customized Equipment (DME) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; 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.