Provider Demographics
NPI:1477538189
Name:THE METHODIST HOSPITALS, INC. O-P
Entity Type:Organization
Organization Name:THE METHODIST HOSPITALS, INC. O-P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADOP PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-886-4315
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:219-886-4315
Mailing Address - Fax:219-881-5160
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:219-886-4315
Practice Address - Fax:219-881-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60002855A333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy