Healthcare Provider Details

I. General information

NPI: 1952462301
Provider Name (Legal Business Name): TERRE HAUTE PULMONARY & PEDIATRIC CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date: 06/19/2007
Reactivation Date: 04/30/2008

III. Provider practice location address

1542 S BLOOMINGTON ST
GREENCASTLE IN
46135-2212
US

IV. Provider business mailing address

4525 S SPRINGHILL JCT
TERRE HAUTE IN
47802-4563
US

V. Phone/Fax

Practice location:
  • Phone: 812-234-6053
  • Fax: 812-234-1722
Mailing address:
  • Phone: 812-234-6053
  • Fax: 812-234-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01052847A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001110A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01038772A
License Number StateIN

VIII. Authorized Official

Name: TRUPTI A BHUPTANI
Title or Position: CO OWNER MD
Credential: MD
Phone: 812-234-6053