Provider Demographics
NPI:1235160938
Name:IMA ENDOSCOPY SURGICENTER P C
Entity Type:Organization
Organization Name:IMA ENDOSCOPY SURGICENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HURWICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-738-2724
Mailing Address - Street 1:8895 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7037
Mailing Address - Country:US
Mailing Address - Phone:219-738-2081
Mailing Address - Fax:
Practice Address - Street 1:8895 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7037
Practice Address - Country:US
Practice Address - Phone:219-738-2081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003667A261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100274530AMedicaid
IN100274530AMedicaid