Provider Demographics
NPI:1972576262
Name:TERRE HAUTE HEART CENTER, INC
Entity type:Organization
Organization Name:TERRE HAUTE HEART CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PRIMO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDRES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:812-238-1521
Mailing Address - Street 1:455 E HOSPITAL LN
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4245
Mailing Address - Country:US
Mailing Address - Phone:812-238-1521
Mailing Address - Fax:
Practice Address - Street 1:455 E HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4245
Practice Address - Country:US
Practice Address - Phone:812-238-1521
Practice Address - Fax:812-232-6335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50002041A261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN060013598OtherRR MEDICARE
IN060013598OtherRR MEDICARE