Healthcare Provider Details

I. General information

NPI: 1326152984
Provider Name (Legal Business Name): TERRE HAUTE PULMONARY & PEDIATRIC CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 S SPRINGHILL JCT
TERRE HAUTE IN
47802-4563
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: 812-478-3416
Mailing address:
  • Phone: 812-234-6053
  • Fax: 812-478-3416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ANAND D BHUPTANI
Title or Position: OWNER
Credential: MD
Phone: 812-234-6053