Provider Demographics
NPI:1215201868
Name:FRANCISCAN HAMMOND CLINIC LLC
Entity Type:Organization
Organization Name:FRANCISCAN HAMMOND CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-836-5800
Mailing Address - Street 1:7905 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2549
Mailing Address - Country:US
Mailing Address - Phone:219-836-5800
Mailing Address - Fax:219-836-8073
Practice Address - Street 1:9800 VALPARAISO COURT
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4040
Practice Address - Country:US
Practice Address - Phone:219-836-5800
Practice Address - Fax:219-836-8073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032154207Q00000X
IN01052057207V00000X
IN01061659208000000X
IN01066795208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201024850Medicaid
IN201024850Medicaid