Provider Demographics
NPI:1477643120
Name:ASSOCIATED PHYSICIANS & SURGEONS CLINIC, LLC
Entity Type:Organization
Organization Name:ASSOCIATED PHYSICIANS & SURGEONS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/AUTHORIZED REPRESENTATIVE
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:812-242-3848
Practice Address - Street 1:RR 1 BOX 994
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-9496
Practice Address - Country:US
Practice Address - Phone:812-232-0564
Practice Address - Fax:812-242-3848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED PHYSICIANS & SURGEONS CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-13
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZD3948OtherOPTIMUM CHOICE INC
0176835OtherUS DEPT OF LABOR
IN301550Medicare PIN
INCA4474Medicare PIN