Provider Demographics
NPI:1043250319
Name:MERRILLVILLE SURGERY CENTER
Entity Type:Organization
Organization Name:MERRILLVILLE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:STANISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-756-4900
Mailing Address - Street 1:101 E. 87TH AVE.
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410
Mailing Address - Country:US
Mailing Address - Phone:219-755-4211
Mailing Address - Fax:219-755-4058
Practice Address - Street 1:101 E. 87TH AVE.
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-755-4211
Practice Address - Fax:219-755-4058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZH7080Medicare PIN