Basic Information
| Provider Information | |||||||||
| NPI: | 1043680515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HPW CENTER FOR DIABETES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3560 S 4TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478025540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122358496 | ||||||||
| FaxNumber: | 8124781540 | ||||||||
| Practice Location | |||||||||
| Address1: | 3560 S 4TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478025540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122358496 | ||||||||
| FaxNumber: | 8124781540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2015 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | PITTMAN | ||||||||
| AuthorizedOfficialFirstName: | ISAIAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8122358496 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | IV | ||||||||
| AuthorizedOfficialCredential: | MD, PHD | ||||||||
| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 01058414 | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.