Organization
TERRE HAUTE NEUROSURGICAL AND SPINE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. G ANDREW WILSON JR. M.D. (OWNER)
(812) 238-4900
Entity
Organization
Contact information
Practice address
1530 N 7TH ST, SUITE 107, TERRE HAUTE, IN 47807-1057
(812) 238-4900
(812) 239-4921
Mailing address
1530 N 7TH ST, SUITE 107, TERRE HAUTE, IN 47807-1057
(812) 238-4900
(812) 239-4921
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01057579A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000295844
BLUECROSS
IN
05
—
200452000A
—
IN
Enumeration date
04/18/2007
Last updated
03/17/2008
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