Organization
UNION ASSOCIATED PHYSICIANS CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL P FOUTY CFO (AUTHORIZED REPRESENTATIVE)
(812) 242-3274
Entity
Organization
Contact information
Practice address
410 N 2ND ST, MARSHALL, IL 62441-1010
(217) 826-2361
Mailing address
221 S 6TH ST, TERRE HAUTE, IN 47807-4214
(812) 242-3274
(812) 242-3861
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DQ0893
RAILROAD MEDICARE
IN
Enumeration date
06/04/2010
Last updated
08/12/2010
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