Basic Information
| Provider Information | |||||||||
| NPI: | 1720130537 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE METHODIST HOSPITALS,INC. - PROGRESSIVE CARE UNIT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | PROGRESSIVE CARE UNIT | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 GRANT ST | ||||||||
| Address2: | ADMINISTRATION BUILDING | ||||||||
| City: | GARY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464026099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198864000 | ||||||||
| FaxNumber: | 2198864603 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 GRANT ST | ||||||||
| Address2: | ADMINISTRATION BUILDING | ||||||||
| City: | GARY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464026099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198864000 | ||||||||
| FaxNumber: | 2198864603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 08/17/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MCFADDON | ||||||||
| AuthorizedOfficialFirstName: | IAN | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 2198864171 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE METHODIST HOSPITALS, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 05-005002-1 | IN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.