1750697348 NPI number — MUNSTER MEDICAL RESEARCH FOUNDATION INC

Table of content: (NPI 1750697348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750697348 NPI number — MUNSTER MEDICAL RESEARCH FOUNDATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MUNSTER MEDICAL RESEARCH FOUNDATION INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMUNITY HOSPITAL ANESTHESIA
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750697348
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 MACARTHUR BOULEVARD
Provider Second Line Business Mailing Address:
ATTN ANESTHESIA
Provider Business Mailing Address City Name:
MUNSTER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46321-2901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-836-7040
Provider Business Mailing Address Fax Number:
219-513-1127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4321 FIR STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST CHICAGO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-392-1700
Provider Business Practice Location Address Fax Number:
219-513-1127
Provider Enumeration Date:
08/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FESKO
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
219-836-1600

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200261490B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000100902 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90000960 . This is a "BCBS ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CE8881 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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