Provider Demographics
NPI:1235209826
Name:MUNSTER MEDICAL RESEARCH FOUNDATION, INC.
Entity Type:Organization
Organization Name:MUNSTER MEDICAL RESEARCH FOUNDATION, INC.
Other - Org Name:COMMUNITY SURGERY CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR PATIENT FINANCIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KULLERSTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-934-8999
Mailing Address - Street 1:801 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2915
Mailing Address - Country:US
Mailing Address - Phone:219-836-2480
Mailing Address - Fax:219-836-0560
Practice Address - Street 1:801 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2915
Practice Address - Country:US
Practice Address - Phone:219-836-2480
Practice Address - Fax:219-836-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005583A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1535650OtherNCPDP PROVIDER IDENTIFICATION NUMBER
IN200330860Medicaid