Basic Information
| Provider Information | |||||||||
| NPI: | 1972818649 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. MARGARET MERCY HEALTHCARE CENTERS INC | ||||||||
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| OtherOrganizationName: | MUNSTER SURGICAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1000 | ||||||||
| Address2: | |||||||||
| City: | DYER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463110800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198642268 | ||||||||
| FaxNumber: | 2198642649 | ||||||||
| Practice Location | |||||||||
| Address1: | 8230 CALUMET AVE | ||||||||
| Address2: | STE 110 FRONT | ||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463211753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198366161 | ||||||||
| FaxNumber: | 2198366205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2010 | ||||||||
| LastUpdateDate: | 08/18/2010 | ||||||||
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| AuthorizedOfficialLastName: | MAPLE | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 2198645296 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 01026156A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.