| Oconnellcaselcswllc | |
|
2501 E 3rd St Bloomington IN 47401-5344 | |
| (804) 695-4577 | |
| Not Available |
| Full Name | Oconnellcaselcswllc |
|---|---|
| Speciality | Social Worker |
| Location | 2501 E 3rd St, Bloomington, Indiana |
| Authorized Official Name and Position | O'connell Case (OWNER) |
| Authorized Official Contact | 8046954577 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oconnellcaselcswllc 3513 E Saddlebrook Ct Bloomington IN 47401-8549 Ph: () - | Oconnellcaselcswllc 2501 E 3rd St Bloomington IN 47401-5344 Ph: (804) 695-4577 |
| NPI Number | 1104496835 |
|---|---|
| Provider Enumeration Date | 06/25/2021 |
| Last Update Date | 08/18/2021 |
| Certification Date | 08/18/2021 |
| Medicare PECOS PAC ID | 0345648317 |
|---|---|
| Medicare Enrollment ID | O20211005001668 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104496835 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | O'connell M Case |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720041163 PECOS PAC ID: 7618116138 Enrollment ID: I20130613000356 |
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