Provider Demographics
NPI:1821320920
Name:SUSAN S. AMOS M.D.P.C.
Entity Type:Organization
Organization Name:SUSAN S. AMOS M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:AMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-232-2936
Mailing Address - Street 1:2929 S 1ST ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3725
Mailing Address - Country:US
Mailing Address - Phone:812-232-2936
Mailing Address - Fax:812-232-9536
Practice Address - Street 1:2929 S 1ST ST
Practice Address - Street 2:SUITE 3
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3725
Practice Address - Country:US
Practice Address - Phone:812-232-2936
Practice Address - Fax:812-232-9536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031117207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100251480AMedicaid