Organization
INDIANA WEST, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRENDA R STALLCOP (CORPORATE MANAGER)
(812) 232-6673
Entity
Organization
Contact information
Practice address
4601 S 7TH ST, TERRE HAUTE, IN 47802-4522
(812) 232-6673
(812) 232-1519
Mailing address
4601 S 7TH ST, TERRE HAUTE, IN 47802-4522
(812) 232-6673
(812) 232-1519
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
50003589
IN
Other
Enumeration date
09/27/2005
Last updated
10/18/2007
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