Healthcare Provider Details

I. General information

NPI: 1407404940
Provider Name (Legal Business Name): UNION ASSOCIATED PHYSICIANS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 SOUTH STATE ROAD 46
TERRE HAUTE IN
47803
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:
Mailing address:
  • Phone: 812-232-0564
  • Fax: 812-242-4509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVE HOLMAN
Title or Position: CEO
Credential:
Phone: 812-238-7606