MEDICARE: ASSOCIATED PHYSICIANS & SURGEONS CLINIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

General Provider Information

NPI Number	:	1982780748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED PHYSICIANS & SURGEONS CLINIC, LLC

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

Provider Business Practice Location Address
First Line	:	2204 N SECTION ST
Second Line	:	SUITE B
City	:	SULLIVAN
State	:	IN
Zip	:	47882-0010
Country	:	US
Telephone Number	:	812-232-0564
Fax Number	:	812-242-3848

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	11/06/2007

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