Organization Active NPI

Family Medicine of Terre Haute, LLC

  • Family Medicine Physician
  • Terre Haute, IN
National Provider Identifier
1801065552
Registry record updated Jan 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAMILY MEDICINE OF TERRE HAUTE, LLC
Practice address
3903 S 7TH St
Suite 2F
Terre Haute, IN 47802-5710
Phone
(812) 237-9890
NPI assigned
Feb 27, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2009

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

Authorized official

Name
Bridgett Sullivan
Title
Office Manager
Phone
(812) 237-9890

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3903 S 7TH St
Suite 2F
Terre Haute, IN 47802-5710

Mailing address

3903 S 7TH St
Suite 2F
Terre Haute, IN 47802-5710
Phone (812) 237-9890

Other identifiers 1

IdentifierTypeStateIssuer
200921400MedicaidIN

National Provider Directory

National Provider Directory

Locations

3903 S 7th St
Ste 2F
Terre Haute, IN 47802
Phone (812) 232-9596

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1204070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231286400000",
    "number": "1801065552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3903 S 7TH ST",
            "address_2": "SUITE 2F",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478025710",
            "telephone_number": "812-237-9890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 S 7TH ST",
            "address_2": "SUITE 2F",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478025710",
            "telephone_number": "812-237-9890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE OF TERRE HAUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-27",
        "last_updated": "2009-01-07",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "BRIDGETT",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "812-237-9890"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200921400",
            "state": "IN"
        }
    ],
    "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 Jan 7, 2009; 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.