Basic Information
| Provider Information | |||||||||
| NPI: | 1396015251 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE METHODIST HOSPITALS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 GRANT ST | ||||||||
| Address2: | |||||||||
| City: | GARY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464026001 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 GRANT ST | ||||||||
| Address2: | |||||||||
| City: | GARY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464026001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198864404 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2012 | ||||||||
| LastUpdateDate: | 03/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | MCFADDEN | ||||||||
| AuthorizedOfficialFirstName: | IAN | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 2198864171 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 11-005002-1 | IN | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 100268630A | 05 | IN | MEDICAID |