Provider Demographics
NPI:1164033676
Name:GARY CITY WORKING AND PROCEDURE CLINIC LLC-S
Entity Type:Organization
Organization Name:GARY CITY WORKING AND PROCEDURE CLINIC LLC-S
Other - Org Name:GARY CITY URGENT AND IMMEDIATE CARE LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOLOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-882-0980
Mailing Address - Street 1:1701 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46407-2238
Mailing Address - Country:US
Mailing Address - Phone:219-882-0980
Mailing Address - Fax:
Practice Address - Street 1:1701 BROADWAY
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46407-2238
Practice Address - Country:US
Practice Address - Phone:219-882-0980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty