| Proactive Mso, Llc | |
|
119 W 7th St Bloomington IN 47404-3926 | |
| (864) 501-0751 | |
| (864) 990-3834 |
| Full Name | Proactive Mso, Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 119 W 7th St, Bloomington, Indiana |
| Authorized Official Name and Position | Jody B Addair (CLINICAL OPS PROJECT COORDINATOR) |
| Authorized Official Contact | 3175560017 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Proactive Mso, Llc 124 Allawood Ct Simpsonville SC 29681-6207 Ph: (864) 501-0751 | Proactive Mso, Llc 119 W 7th St Bloomington IN 47404-3926 Ph: (864) 501-0751 |
| NPI Number | 1275371080 |
|---|---|
| Provider Enumeration Date | 07/16/2024 |
| Last Update Date | 07/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275371080 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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