Healthcare Provider Details

I. General information

NPI: 1528178886
Provider Name (Legal Business Name): JOHN CHARLES WELCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 N 4TH ST
TERRE HAUTE IN
47804-4002
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 812-242-3600
  • Fax: 812-242-3620
Mailing address:
  • Phone: 812-242-3600
  • Fax: 812-242-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01033616A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number01033616A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: