Provider Demographics
NPI:1033876438
Name:DUNE GRASS SURGICAL SUITES, LLC
Entity Type:Organization
Organization Name:DUNE GRASS SURGICAL SUITES, LLC
Other - Org Name:DUNE GRASS SURGICAL SUITES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:EIDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-331-6731
Mailing Address - Street 1:505 PINTAIL TRACE
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304
Mailing Address - Country:US
Mailing Address - Phone:219-799-2029
Mailing Address - Fax:219-799-2028
Practice Address - Street 1:505 PINTAIL TRACE
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304
Practice Address - Country:US
Practice Address - Phone:219-799-2029
Practice Address - Fax:219-799-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical