Provider Demographics
NPI:1528178886
Name:WELCH, JOHN CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:WELCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:812-242-3600
Mailing Address - Fax:812-242-3620
Practice Address - Street 1:1739 N 4TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4002
Practice Address - Country:US
Practice Address - Phone:812-242-3600
Practice Address - Fax:812-242-3620
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033616A207Q00000X, 207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000089603OtherANTHEM
INP00837320OtherRAILROAD MEDICARE
080061866OtherRAILROAD MCARE PALAMETTO
IN100252260Medicaid
IN192770TTTMedicare PIN
IN100252260Medicaid
IN265130WMedicare PIN
INP00837320OtherRAILROAD MEDICARE
IN859920GMedicare PIN