ASSOCIATED PHYSICIANS & SURGEONS CLINIC, LLC

Provider Demographics

• NPI: 1679680672
• Name: ASSOCIATED PHYSICIANS & SURGEONS CLINIC, LLC
• Entity Type: Organization
• Organization Name: ASSOCIATED PHYSICIANS & SURGEONS CLINIC, LLC
• Authorized Official - Title/Position: CFO/AUTHORIZED REPRESENTATIVE
• Authorized Official - Prefix: MR
• Authorized Official - First Name: MICHAEL
• Authorized Official - Middle Name: P
• Authorized Official - Last Name: FOUTY
• Authorized Official - Phone: 812-232-0564
• Mailing Address - Street 1: 221 S 6TH ST
• 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: 221 S 6TH ST
• Practice Address - City: TERRE HAUTE
• Practice Address - State: IN
• Practice Address - Zip Code: 47807-4214
• Practice Address - Country: US
• Practice Address - Phone: 812-232-0564
• Practice Address - Fax: 812-242-3848
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-08-24
• Last Update Date: 2007-11-01

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	207K00000X	Allopathic & Osteopathic Physicians	Allergy & Immunology		Group - Multi-Specialty
No	207N00000X	Allopathic & Osteopathic Physicians	Dermatology		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207RA0201X	Allopathic & Osteopathic Physicians	Internal Medicine	Allergy & Immunology	Group - Multi-Specialty
No	207RC0000X	Allopathic & Osteopathic Physicians	Internal Medicine	Cardiovascular Disease	Group - Multi-Specialty
No	207RC0200X	Allopathic & Osteopathic Physicians	Internal Medicine	Critical Care Medicine	Group - Multi-Specialty
No	207RE0101X	Allopathic & Osteopathic Physicians	Internal Medicine	Endocrinology, Diabetes & Metabolism	Group - Multi-Specialty
No	207RG0100X	Allopathic & Osteopathic Physicians	Internal Medicine	Gastroenterology	Group - Multi-Specialty
No	207RH0003X	Allopathic & Osteopathic Physicians	Internal Medicine	Hematology & Oncology	Group - Multi-Specialty
No	207RI0200X	Allopathic & Osteopathic Physicians	Internal Medicine	Infectious Disease	Group - Multi-Specialty
No	207RP1001X	Allopathic & Osteopathic Physicians	Internal Medicine	Pulmonary Disease	Group - Multi-Specialty
No	207RR0500X	Allopathic & Osteopathic Physicians	Internal Medicine	Rheumatology	Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	207W00000X	Allopathic & Osteopathic Physicians	Ophthalmology		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IN	230650	Medicare PIN
IN	611880	Medicare PIN
IN	859920	Medicare PIN
IN	192770	Medicare PIN
IN	780920	Medicare PIN
IL	364251	Medicare PIN
IL	387250	Medicare PIN
IN	0816010001	Medicare NSC
IN	301550	Medicare PIN
IN	607850	Medicare PIN
IN	859910	Medicare PIN
IN	CA4474	Medicare PIN
IN	130840	Medicare PIN
IN	859930	Medicare PIN
IN	859960	Medicare PIN
IN	859940	Medicare PIN
IL	CE0949	Medicare PIN
IN	187310	Medicare PIN