Organization Name: | INDIANA WEST, PC |
NPI Number: | 1487640140 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRENDA R STALLCOP (CORPORATE MANAGER) |
Mailing Address: | 4601 S 7th St Terre Haute |
State: | IN US |
Postal Code: | 478024522 |
Phone Number: | 8122326673 |
Fax Number: | 8122321519 |
NPI Enumeration Date: | 09/27/2005 |
NPI Last Update Date: | 10/18/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 50003589 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |