Provider Demographics
NPI:1700889037
Name:PATHOLOGY ASSOCIATES OF TERRE HAUTE, INC.
Entity Type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF TERRE HAUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CHIEF MEDICAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:DEPOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-244-0100
Mailing Address - Street 1:PO BOX 9524
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47808-9524
Mailing Address - Country:US
Mailing Address - Phone:812-244-0100
Mailing Address - Fax:812-232-1517
Practice Address - Street 1:1606 N 7TH STREET
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-2706
Practice Address - Country:US
Practice Address - Phone:812-244-0100
Practice Address - Fax:812-232-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100252400Medicaid
IN858090Medicare ID - Type Unspecified