Basic Information
| Provider Information | |||||||||
| NPI: | 1386917912 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRANCISCAN HAMMOND CLINIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7905 CALUMET AVE | ||||||||
| Address2: | |||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463212549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198365800 | ||||||||
| FaxNumber: | 2198368073 | ||||||||
| Practice Location | |||||||||
| Address1: | 11355 W 97TH LN | ||||||||
| Address2: | |||||||||
| City: | SAINT JOHN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463739601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198365800 | ||||||||
| FaxNumber: | 2198368073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2012 | ||||||||
| LastUpdateDate: | 03/28/2012 | ||||||||
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| AuthorizedOfficialLastName: | DELAO | ||||||||
| AuthorizedOfficialFirstName: | BEVERLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2198365800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 01021975 | IN | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | 207V00000X | 01027708 | IN | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 208000000X | 01028626 | IN | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207Q00000X | 02002075 | IN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 201024850 | 05 | IN | MEDICAID |