| Indiana State University | |
|
567 N 5th St Terre Haute IN 47809-1903 | |
| (812) 237-3883 | |
| (812) 237-7955 |
| Full Name | Indiana State University |
|---|---|
| Speciality | Family Medicine |
| Location | 567 N 5th St, Terre Haute, Indiana |
| Authorized Official Name and Position | Michael Marietta (REVENUE CYCLE DIRECTOR) |
| Authorized Official Contact | 8122320564 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indiana State University 221 S 6th St Terre Haute IN 47807-4214 Ph: (812) 232-0564 | Indiana State University 567 N 5th St Terre Haute IN 47809-1903 Ph: (812) 237-3883 |
| NPI Number | 1326588997 |
|---|---|
| Provider Enumeration Date | 03/02/2017 |
| Last Update Date | 03/02/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326588997 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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