Basic Information
| Provider Information | |||||||||
| NPI: | 1487606489 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TERRE HAUTE PAIN CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1183 E CANVASBACK DR | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478025304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177813604 | ||||||||
| FaxNumber: | 3177803345 | ||||||||
| Practice Location | |||||||||
| Address1: | 1183 E CANVASBACK DR | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478025304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177813604 | ||||||||
| FaxNumber: | 3177803345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | OCHSNER | ||||||||
| AuthorizedOfficialFirstName: | SANDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 3177813604 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | BUSINESS OFFICE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 01026731A | IN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.