Healthcare Provider Details

I. General information

NPI: 1508950460
Provider Name (Legal Business Name): ASSOCIATED PHYSICIANS & SURGEIONS CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 E NATIONAL AVE
BRAZIL IN
47834-2718
US

IV. Provider business mailing address

221 S 6TH ST
TERRE HAUTE IN
47807-4214
US

V. Phone/Fax

Practice location:
  • Phone: 812-232-0564
  • Fax: 812-242-3848
Mailing address:
  • Phone: 812-232-0564
  • Fax: 812-242-3848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL P FOUTY
Title or Position: CFO/AUTHORIZED REPRESENTATIVE
Credential:
Phone: 812-232-0564