1811152572 NPI number — ST. MARGARET MERCY HEALTHCARE CENTERS, INC

Table of content: (NPI 1811152572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811152572 NPI number — ST. MARGARET MERCY HEALTHCARE CENTERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. MARGARET MERCY HEALTHCARE CENTERS, 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:
Provider Other Organization Name Type Code:
6
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:
1811152572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DYER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46311-0800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-864-2107
Provider Business Mailing Address Fax Number:
219-864-2649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 HOHMAN AVENUE
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46320-1942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-852-1505
Provider Business Practice Location Address Fax Number:
219-852-1510
Provider Enumeration Date:
07/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GRYZBEK
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
219-933-2300

Provider Taxonomy Codes

  • Taxonomy code: 207YX0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200504980 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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