Healthcare Provider Details

I. General information

NPI: 1700203544
Provider Name (Legal Business Name): FCC TERRE HAUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 BUREAU RD N
TERRE HAUTE IN
47802-8128
US

IV. Provider business mailing address

4200 BUREAU RD N
TERRE HAUTE IN
47802-8128
US

V. Phone/Fax

Practice location:
  • Phone: 812-244-4400
  • Fax: 812-244-4753
Mailing address:
  • Phone: 812-244-4400
  • Fax: 812-244-4753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW RUPSKA
Title or Position: HEALTH SERVICE ADMINISTRATOR
Credential:
Phone: 812-244-4400