Provider Demographics
NPI:1164427084
Name:ST. MARGARET MERCY HEALTHCARE CENTER
Entity Type:Organization
Organization Name:ST. MARGARET MERCY HEALTHCARE CENTER
Other - Org Name:ST. MARGARET MERCY HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRYZBEK
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:219-932-2300
Mailing Address - Street 1:5454 HOHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-1931
Mailing Address - Country:US
Mailing Address - Phone:800-353-2961
Mailing Address - Fax:219-933-2641
Practice Address - Street 1:5454 HOHMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1931
Practice Address - Country:US
Practice Address - Phone:800-353-2961
Practice Address - Fax:219-933-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0456310005Medicare ID - Type Unspecified