Basic Information
| Provider Information | |||||||||
| NPI: | 1790868016 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACUTE MEDICAL CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1145 INDIANAPOLIS RD | ||||||||
| Address2: | |||||||||
| City: | GREENCASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461352408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656538453 | ||||||||
| FaxNumber: | 7656538493 | ||||||||
| Practice Location | |||||||||
| Address1: | 1145 INDIANAPOLIS RD | ||||||||
| Address2: | |||||||||
| City: | GREENCASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461352408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656538453 | ||||||||
| FaxNumber: | 7656538493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 05/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | BLACK | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | HOUSTON | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7656538453 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200125540A | 05 | IN | MEDICAID |