Basic Information
| Provider Information | |||||||||
| NPI: | 1609104033 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE METHODIST HOSPITALS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | METHODIST SURGICAL SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6121 CLEVELAND ST | ||||||||
| Address2: | |||||||||
| City: | MERRILLVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464102302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197385985 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 650 GRANT ST | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | GARY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464041533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198864356 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2009 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | DOYLE | ||||||||
| AuthorizedOfficialFirstName: | MATT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2198864171 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 09/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.