Provider Demographics
NPI:1366450165
Name:NORTHWEST EMERGENCY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NORTHWEST EMERGENCY ASSOCIATES, LLC
Other - Org Name:NORTHWEST EMERGENCY ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-886-4289
Mailing Address - Street 1:600 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46402-6001
Mailing Address - Country:US
Mailing Address - Phone:219-886-4289
Mailing Address - Fax:219-881-5184
Practice Address - Street 1:600 GRANT ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-6001
Practice Address - Country:US
Practice Address - Phone:219-886-4289
Practice Address - Fax:219-881-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200864550Medicaid
IN237730Medicare PIN