Provider Demographics
NPI:1164411229
Name:WABASH VALLEY HOSPITALISTS LLC
Entity Type:Organization
Organization Name:WABASH VALLEY HOSPITALISTS LLC
Other - Org Name:NO DBA WABASH VALLEY HOSPITALISTS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7625
Mailing Address - Street 1:3901 S 7TH ST
Mailing Address - Street 2:ROOM 452
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5709
Mailing Address - Country:US
Mailing Address - Phone:812-237-9217
Mailing Address - Fax:812-237-1395
Practice Address - Street 1:3901 S 7TH ST
Practice Address - Street 2:ROOM 452
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5709
Practice Address - Country:US
Practice Address - Phone:812-237-9217
Practice Address - Fax:812-237-1395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN221780Medicare ID - Type Unspecified