Provider Demographics
NPI:1225309073
Name:INDIANA PHYSICIAN MANAGEMENT-MERCY, LLC
Entity Type:Organization
Organization Name:INDIANA PHYSICIAN MANAGEMENT-MERCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:
Authorized Official - Last Name:BICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-844-7440
Mailing Address - Street 1:7197 SOLUTION CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-7001
Mailing Address - Country:US
Mailing Address - Phone:317-870-0480
Mailing Address - Fax:317-870-0499
Practice Address - Street 1:1331 S A ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-1942
Practice Address - Country:US
Practice Address - Phone:765-552-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201073550AMedicaid
INM100073216Medicare PIN