Provider Demographics
NPI:1639152895
Name:NORTHERN INDIANA ONCOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:NORTHERN INDIANA ONCOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-472-6400
Mailing Address - Street 1:720 CEDAR ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2060
Mailing Address - Country:US
Mailing Address - Phone:274-472-6400
Mailing Address - Fax:574-472-6414
Practice Address - Street 1:720 CEDAR ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2060
Practice Address - Country:US
Practice Address - Phone:274-472-6400
Practice Address - Fax:574-472-6414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN177110Medicare ID - Type Unspecified