Active NPI
Alex Vandeusen
- Athletic Trainer
- Terre Haute, IN
National Provider Identifier
1790101186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 36002010A
- Practice address
- 1606 N 7TH St
Terre Haute, IN 47804-2706 - Phone
- (812) 238-7000
- NPI assigned
- Mar 10, 2014
- Last updated
- Feb 14, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 36002010A | IN | Primary |
Addresses
Primary practice location
1606 N 7TH St
Terre Haute, IN 47804-2706
Mailing address
4300 Old Paris Rd
Apt. P
West Terre Haute, IN 47885-9025
Phone (607) 435-8959
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36002010A | IN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1394409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487030400000",
"number": "1790101186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4300 OLD PARIS RD",
"address_2": "APT. P",
"city": "WEST TERRE HAUTE",
"state": "IN",
"postal_code": "478859025",
"telephone_number": "607-435-8959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1606 N 7TH ST",
"city": "TERRE HAUTE",
"state": "IN",
"postal_code": "478042706",
"telephone_number": "812-238-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDEUSEN",
"first_name": "ALEX",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-03-10",
"last_updated": "2017-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36002010A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Terre Haute, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.