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NPI Code Detail

MEDICARE: ASSSOCIATED PHYSICIANS & SURGEONS CLINIC, LLC

MEDICARE: ASSSOCIATED PHYSICIANS & SURGEONS CLINIC, LLC
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
1208800000XUrology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10176835OTHERUS DEPT OF LABOR
2ZD3948OTHEROPTIMUM CHOICE INC

General Provider Information

NPI Number : 1750471413
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASSSOCIATED PHYSICIANS & SURGEONS CLINIC, LLC
Provider Business Mailing Address
First Line : 221 S 6TH ST
Second Line :
City : TERRE HAUTE
State : IN
Zip : 47807-4214
Country : US
Telephone Number : 812-232-0564
Fax Number : 812-242-3848
Provider Business Practice Location Address
First Line : 410 N 2ND ST
Second Line :
City : MARSHALL
State : IL
Zip : 62441-1010
Country : US
Telephone Number : 812-232-0564
Fax Number : 812-242-3848
Authorized Official
Title or Position : CFO/AUTHORIZED REPRESENTATIVE
Name : MICHAEL P FOUTY
Credential :
Telephone Number : 812-232-0564
Provider Enumeration Date : 10/13/2006
Last Update Date : 11/06/2007

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Directions to “ASSSOCIATED PHYSICIANS & SURGEONS CLINIC, LLC ” Practice Location

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