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General NPI Number Information
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NPI Number | 1962586198
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Entity Type | Organization
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Legal Business Name | ASSOCIATED PHYSICIANS & SURGEONS CLINIC, LLC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1739 N 4TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47804-4002
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Country | US
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Telephone | 812-232-0564
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Fax | 812-242-3848
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Provider Business Mailing Address
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Address Line | 221 S 6TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47807-4214
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Country | US
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Telephone | 812-232-0564
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Fax | 812-242-3848
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Authorized Official
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Title or Position | CFO/AUTHORIZED REPRESENTATIVE
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Name | MICHAEL P FOUTY
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Credential |
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Telephone | 812-232-0564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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