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General NPI Number Information
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NPI Number | 1275536195
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Entity Type | Organization
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Legal Business Name | TERRE HAUTE MEDICAL LABORATORY, INC
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 1606 N 7TH STREET
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City | TERRE HAUTE
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State | IN
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Zip | 47804-2706
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Country | US
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Telephone | 812-244-0100
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Fax | 812-232-1517
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Provider Business Mailing Address
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Address Line | PO BOX 9359 634 BEECH STREET
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City | TERRE HAUTE
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State | IN
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Zip | 47808-9359
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Country | US
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Telephone | 812-244-0100
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Fax | 812-232-1517
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Authorized Official
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Title or Position | PRESIDENT AND CHIEF MEDICAL OFFICER
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Name | MR. WILLIAM D. DEPOND
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Credential | M.D.
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Telephone | 812-244-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 50000920A
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License Number State | IN
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