Healthcare Provider Details

I. General information

NPI: 1396920203
Provider Name (Legal Business Name): ASSOCIATED PHYSICIANS & SURGEONS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 N 6 1/2 ST STE 200
TERRE HAUTE IN
47804-2766
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: 812-242-3848
Mailing address:
  • Phone: 812-232-0564
  • Fax: 812-242-3848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL P FOUTY
Title or Position: CFO AUTHORIZED REPRESENTATIVE
Credential:
Phone: 812-232-0564