Provider Demographics
NPI:1255665451
Name:UNION ASSOCIATED PHYSICIANS CLINIC, LLC
Entity Type:Organization
Organization Name:UNION ASSOCIATED PHYSICIANS CLINIC, LLC
Other - Org Name:
Other - Org Type:
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:812-232-0564
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:812-242-3861
Practice Address - Street 1:1530 N 7TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1057
Practice Address - Country:US
Practice Address - Phone:812-242-3115
Practice Address - Fax:812-235-9580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION ASSOCIATED PHYSICIANS CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-22
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200975660Medicaid
INDQ0893OtherRAILROAD MEDICARE
INDQ0893OtherRAILROAD MEDICARE
IN265130Medicare PIN