Provider Demographics
NPI:1326152984
Name:TERRE HAUTE PULMONARY & PEDIATRIC CLINIC, LLC
Entity Type:Organization
Organization Name:TERRE HAUTE PULMONARY & PEDIATRIC CLINIC, LLC
Other - Org Name:SPRINGHILL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:D
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:812-478-3416
Practice Address - Street 1:4525 S SPRINGHILL JCT
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4563
Practice Address - Country:US
Practice Address - Phone:812-234-6053
Practice Address - Fax:812-478-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200391150EMedicaid
IN200391150JMedicaid
IN200391150DMedicaid
IN200391150NMedicaid
IN200391150OMedicaid
IN200391150AMedicaid
IN200391150LMedicaid
IN200391150QMedicaid
IN200391150MMedicaid
IN200391150PMedicaid
IN200391150IMedicaid
IN200391150KMedicaid
IN182180Medicare PIN