Terre Haute Neurosurgical and Spine Clinic, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

01057579A Issued in IN

Legal business name

TERRE HAUTE NEUROSURGICAL AND SPINE CLINIC, LLC

Practice address

1530 N 7TH St
Suite 107
Terre Haute, IN 47807-1057

Phone

(812) 238-4900

Fax

(812) 239-4921

NPI assigned

Apr 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. G Andrew Wilson Jr., M.D.

Title

Owner

Phone

(812) 238-4900

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205712000000",
    "number": "1225254808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 N 7TH ST",
            "address_2": "SUITE 107",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478071057",
            "telephone_number": "812-238-4900",
            "fax_number": "812-239-4921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 N 7TH ST",
            "address_2": "SUITE 107",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478071057",
            "telephone_number": "812-238-4900",
            "fax_number": "812-239-4921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TERRE HAUTE NEUROSURGICAL AND SPINE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2008-03-17",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "G",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-238-4900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IN",
            "license": "01057579A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS",
            "identifier": "000000295844",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200452000A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Terre Haute Neurosurgical & Spine Clinic, LLC
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• Terre Haute Oral & Maxillofacial Surgery
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• Terre Haute Pain Care PC
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• Specialist in Terre Haute, IN
• Providers in Terre Haute, IN by specialty
• Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.