Healthcare Provider Details

I. General information

NPI: 1497449367
Provider Name (Legal Business Name): URGENT SPECIALTY ASSOCIATES OF INDIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 S 7TH ST
TERRE HAUTE IN
47802-5709
US

IV. Provider business mailing address

13500 POWERS CT STE 230
FORT MYERS FL
33912-4503
US

V. Phone/Fax

Practice location:
  • Phone: 812-232-0021
  • Fax:
Mailing address:
  • Phone: 817-856-0655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN D JOSEPHS
Title or Position: PRESIDENT
Credential: MD
Phone: 469-766-8747