Provider Demographics
NPI:1184028912
Name:UNION ASSOCIATED PHYSICIANS CLINIC, LLC
Entity Type:Organization
Organization Name:UNION ASSOCIATED PHYSICIANS CLINIC, LLC
Other - Org Name:ROSE HULMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:FOUTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-242-3434
Mailing Address - Street 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-232-0564
Mailing Address - Fax:812-242-4590
Practice Address - Street 1:5500 WABASH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-3920
Practice Address - Country:US
Practice Address - Phone:812-877-8367
Practice Address - Fax:812-872-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty