Organization
UNION ASSOCIATED PHYSICIANS CLINIC, LLC
Active
Parent organization
UNION ASSOCIATED PHYSICIANS CLINIC, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNION ASSOCIATED PHYSICIANS CLINIC, LLC
Authorized official
MICHAEL P FOUTY (CFO)
(812) 232-0564
Entity
Organization
Contact information
Practice address
890 RIDGELAWN ROAD, MARTINSVILLE, IL 62442-0399
(217) 382-4191
Mailing address
221 S 6TH ST, TERRE HAUTE, IN 47807-4214
(812) 232-0564
(812) 242-3861
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RX0202X
Medical Oncology Physician
Primary
—
—
208800000X
Urology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200975660
—
IN
01
—
DQ0893
RAILROAD MEDICARE
IN
01
—
DQ7114
RAILROAD MEDICARE
IL
Enumeration date
09/22/2009
Last updated
12/13/2010
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