Provider Demographics
NPI:1700203544
Name:FCC TERRE HAUTE
Entity Type:Organization
Organization Name:FCC TERRE HAUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:RUPSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-244-4400
Mailing Address - Street 1:4200 BUREAU RD N
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-8128
Mailing Address - Country:US
Mailing Address - Phone:812-244-4400
Mailing Address - Fax:812-244-4753
Practice Address - Street 1:4200 BUREAU RD N
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-8128
Practice Address - Country:US
Practice Address - Phone:812-244-4400
Practice Address - Fax:812-244-4753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service