Provider Demographics
NPI:1083712574
Name:HOUSER-NORBORG-MACGREGOR MEDICAL CORP
Entity Type:Organization
Organization Name:HOUSER-NORBORG-MACGREGOR MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-232-2038
Mailing Address - Street 1:515 N LAFAYETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1003
Mailing Address - Country:US
Mailing Address - Phone:574-232-2037
Mailing Address - Fax:574-232-1420
Practice Address - Street 1:515 N LAFAYETTE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1003
Practice Address - Country:US
Practice Address - Phone:574-232-2037
Practice Address - Fax:574-232-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50000406A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0524100001Medicare NSC
IN238760Medicare PIN