Organization
FAMILY MEDICINE OF TERRE HAUTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIDGETT SULLIVAN (OFFICE MANAGER)
(812) 237-9890
Entity
Organization
Contact information
Practice address
3903 S 7TH ST, SUITE 2F, TERRE HAUTE, IN 47802-5710
(812) 237-9890
Mailing address
3903 S 7TH ST, SUITE 2F, TERRE HAUTE, IN 47802-5710
(812) 237-9890
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200921400
—
IN
Enumeration date
02/27/2008
Last updated
01/07/2009
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