=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952462301
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TERRE HAUTE PULMONARY & PEDIATRIC CLINIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 09/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1542 S BLOOMINGTON ST
-----------------------------------------------------
City | GREENCASTLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46135-2212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-234-6053
-----------------------------------------------------
Fax | 812-234-1722
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4525 S SPRINGHILL JCT
-----------------------------------------------------
City | TERRE HAUTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47802-4563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-234-6053
-----------------------------------------------------
Fax | 812-234-1722
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO OWNER MD
-----------------------------------------------------
Name | TRUPTI A BHUPTANI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 812-234-6053
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 01052847A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 71001110A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 01038772A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------