Basic Information
| Provider Information | |||||||||
| NPI: | 1518698141 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE METHODIST HOSPITALS, INC | ||||||||
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| OtherOrganizationName: | METHODIST ENT | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6121 CLEVELAND ST | ||||||||
| Address2: | |||||||||
| City: | MERRILLVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464102302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197385985 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 GRANT ST | ||||||||
| Address2: | |||||||||
| City: | GARY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464026099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198864000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2022 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | DOYLE | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | SHAWN | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7732575964 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE METHODIST HOSPITALS, INC | ||||||||
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| NPICertificationDate: | 09/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.