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1275536195

NPI Code Detail

MEDICARE: TERRE HAUTE MEDICAL LABORATORY, INC

MEDICARE: TERRE HAUTE MEDICAL LABORATORY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	50000920A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275536195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRE HAUTE MEDICAL LABORATORY, INC

Provider Business Mailing Address
First Line	:	PO BOX 9359
Second Line	:	634 BEECH STREET
City	:	TERRE HAUTE
State	:	IN
Zip	:	47808-9359
Country	:	US
Telephone Number	:	812-244-0100
Fax Number	:	812-232-1517

Provider Business Practice Location Address
First Line	:	1606 N 7TH STREET
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47804-2706
Country	:	US
Telephone Number	:	812-244-0100
Fax Number	:	812-232-1517

Authorized Official
Title or Position	:	PRESIDENT AND CHIEF MEDICAL OFFICER
Name	:	MR. WILLIAM D. DEPOND
Credential	:	M.D.
Telephone Number	:	812-244-0100

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	12/02/2010

Similar Medicare Providers

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Practice Location Address:

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1346243508 — RAMONA C JORA M.D.
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1033112297 — ASUNCION U DEWITT M.D.
Practice Location Address:

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TERRE HAUTE, IN
47804-2706

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1396748992 — DR. SCOTT LORING ACKLEY MD
Practice Location Address:

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TERRE HAUTE, IN
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1306849872 — DR. ROBERT HAERR MD
Practice Location Address:

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Directions to “TERRE HAUTE MEDICAL LABORATORY, INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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