1356431019 NPI number — ASSSOCIATED PHYSICIANS & SURGEONS CLINIC, LLC

Table of content: (NPI 1356431019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356431019 NPI number — ASSSOCIATED PHYSICIANS & SURGEONS CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSSOCIATED PHYSICIANS & SURGEONS CLINIC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356431019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 S 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TERRE HAUTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47807-4214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-232-0564
Provider Business Mailing Address Fax Number:
812-242-3848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RR 1 BOX 1000
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47441-9482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-232-0564
Provider Business Practice Location Address Fax Number:
812-242-3848
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOUTY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CFO/AUTHORIZED REPRESENTATIVE
Authorized Official Telephone Number:
812-232-0564

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0176835 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".




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