Provider Demographics
NPI:1083657837
Name:TERRE HAUTE HEART LUNG VASCULAR ASSO LLC
Entity Type:Organization
Organization Name:TERRE HAUTE HEART LUNG VASCULAR ASSO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-232-2708
Mailing Address - Street 1:3903 S 7TH ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5710
Mailing Address - Country:US
Mailing Address - Phone:812-232-2708
Mailing Address - Fax:
Practice Address - Street 1:3903 S 7TH ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5710
Practice Address - Country:US
Practice Address - Phone:812-232-2708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN231690Medicare PIN