Provider Demographics
NPI:1215045901
Name:TERRE HAUTE PULMONARY & PEDIATRIC CLINIC, LLC
Entity Type:Organization
Organization Name:TERRE HAUTE PULMONARY & PEDIATRIC CLINIC, LLC
Other - Org Name:DUGGER MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER MD
Authorized Official - Prefix:
Authorized Official - First Name:TRUPTI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BHUPTANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-234-6053
Mailing Address - Street 1:4525 S SPRINGHILL JCT
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4563
Mailing Address - Country:US
Mailing Address - Phone:812-234-6053
Mailing Address - Fax:812-234-1722
Practice Address - Street 1:1005 S 3RD ST
Practice Address - Street 2:
Practice Address - City:DUGGER
Practice Address - State:IN
Practice Address - Zip Code:47848-5011
Practice Address - Country:US
Practice Address - Phone:812-648-2231
Practice Address - Fax:812-648-2968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2016-09-29
Deactivation Date:2007-06-19
Deactivation Code:
Reactivation Date:2008-04-30
Provider Licenses
StateLicense IDTaxonomies
IN01045492A207R00000X, 208D00000X
IN01055950A207R00000X
IN01052847A207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN182180DOtherDESHPANDE MEDICARE #
IN200314660MedicaidAJAY DESHPANDE MEDICAID #
IN200111590MedicaidPUROHIT MEDICAID #
IN182180FOtherPUROHIT MCR #
IN200386870MedicaidSHREELEKHA MEDICAID #
IN200391150DMedicaidMEDICAID # DUGGER
IN200314660MedicaidAJAY DESHPANDE MEDICAID #
IN200386870MedicaidSHREELEKHA MEDICAID #
IN182180Medicare PIN
IN182180DOtherDESHPANDE MEDICARE #
IN182180Medicare PIN