Provider Demographics
NPI:1619280120
Name:NORTHWEST PROCEDURES MEDICAL CENTERS AND IMMEDIATE CARE CENTERS
Entity Type:Organization
Organization Name:NORTHWEST PROCEDURES MEDICAL CENTERS AND IMMEDIATE CARE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:OKECHUKW
Authorized Official - Last Name:ONYEUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-397-1951
Mailing Address - Street 1:2010 E COLUMBUS DR
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-2830
Mailing Address - Country:US
Mailing Address - Phone:219-397-1951
Mailing Address - Fax:219-844-3578
Practice Address - Street 1:2010 E COLUMBUS DR
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-2830
Practice Address - Country:US
Practice Address - Phone:219-397-1951
Practice Address - Fax:219-844-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043017B207QG0300X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01043017BOtherINDIANA LICENSE
IN20027940Medicaid