Basic Information
| Provider Information | |||||||||
| NPI: | 1760902993 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNION ASSOCIATED PHYSICIANS CLINIC, LLC | ||||||||
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| OtherOrganizationName: | UNION ASSOCIATED PHYSICIANS CLINIC, LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478074214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122320564 | ||||||||
| FaxNumber: | 8122423861 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ST MARY OF WOODS COLL | ||||||||
| Address2: | |||||||||
| City: | SAINT MARY OF THE WOODS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478761098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122320564 | ||||||||
| FaxNumber: | 8122423861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2017 | ||||||||
| LastUpdateDate: | 06/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | MARIETTA | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | REV CYC DIR | ||||||||
| AuthorizedOfficialTelephone: | 8122320564 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UNION ASSOCIATED PHYSICIANS CLINIC, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.