1396744389 NPI number — MUNSTER MEDICAL RESEARCH FOUNDATION INC

Table of content: (NPI 1396744389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396744389 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 CARE CENTER FOR WOMEN
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:
1396744389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9660 WICKER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST JOHN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46373-9487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-836-5040
Provider Business Mailing Address Fax Number:
219-836-6835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9100 COLUMBIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNSTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46321-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-836-5040
Provider Business Practice Location Address Fax Number:
219-836-6835
Provider Enumeration Date:
07/20/2005

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: 207V00000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 90000961 . This is a "BCBS OF ILLINOIS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200281190A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ4617 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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