Basic Information
| Provider Information | |||||||||
| NPI: | 1275643488 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ULRICH | ||||||||
| FirstName: | GARY | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478074214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122423005 | ||||||||
| FaxNumber: | 8122423054 | ||||||||
| Practice Location | |||||||||
| Address1: | 1725 N 5TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478044010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122423005 | ||||||||
| FaxNumber: | 8122423054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 08/18/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 02001444A | IN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100253060W | 05 | IN | MEDICAID | 100253060Y | 05 | IN | MEDICAID | 255439 | 01 | HEALTHLINK | OTHER | 100253060T | 05 | IN | MEDICAID | P00834674 | 01 | IN | RAILROAD MEDICARE | OTHER | 100253060G | 01 | IN | MOLINA HEALTHCARE MCAID | OTHER | 200024206 | 01 | RAILROAD MCARE PALAMETTO | OTHER | 100253060O | 01 | IN | MOLINA HEALTHCARE MCAID | OTHER | 100253060 | 05 | IN | MEDICAID | 000000089591 | 01 | ANTHEM | OTHER |