Provider Demographics
NPI:1790789139
Name:TERRE HAUTE HOME HEALTH CARE PRODUCTS INC
Entity Type:Organization
Organization Name:TERRE HAUTE HOME HEALTH CARE PRODUCTS INC
Other - Org Name:ANDERSON'S MEDICAL PRODUCTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-234-6084
Mailing Address - Street 1:4411 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4359
Mailing Address - Country:US
Mailing Address - Phone:812-234-6084
Mailing Address - Fax:812-234-5691
Practice Address - Street 1:4411 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4359
Practice Address - Country:US
Practice Address - Phone:812-234-6084
Practice Address - Fax:812-234-5691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69000145A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100251310Medicaid
IL000000251101OtherANTHEM PROVIDER #
IN=========OtherTAX ID #
IL=========001Medicaid
IN=========OtherTAX ID #