Basic Information
| Provider Information | |||||||||
| NPI: | 1710039508 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE METHODIST HOSPITALS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 GRANT ST | ||||||||
| Address2: | ADMINISTRATION BUILDING | ||||||||
| City: | GARY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464026001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198864404 | ||||||||
| FaxNumber: | 2198815199 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 GRANT ST | ||||||||
| Address2: | ADMINISTRATION BUILDING | ||||||||
| City: | GARY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464026001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198864404 | ||||||||
| FaxNumber: | 2198815199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 09/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | MCFADDON | ||||||||
| AuthorizedOfficialFirstName: | IAN | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 2198864404 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE METHODIST HOSPITALS,INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | 06-005002-1 | IN | Y | Hospital Units | Rehabilitation Unit |
ID Information
| ID | Type | State | Issuer | Description | 100268630C | 05 | IN | MEDICAID | 100268630B | 05 | IN | MEDICAID | 100268630A | 05 | IN | MEDICAID |