Provider Demographics
NPI:1689758583
Name:HIGH RISK OBSTETRICS & DIAGNOSTICS SC
Entity Type:Organization
Organization Name:HIGH RISK OBSTETRICS & DIAGNOSTICS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT HIGH RISK OB
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:LOSURE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-213-2280
Mailing Address - Street 1:1205 S MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3676
Mailing Address - Country:US
Mailing Address - Phone:219-213-2280
Mailing Address - Fax:219-213-2280
Practice Address - Street 1:1205 S MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3676
Practice Address - Country:US
Practice Address - Phone:219-213-2280
Practice Address - Fax:219-213-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058922OtherLICENSE
IL036076900OtherLICENSE
C45077Medicare UPIN
IL036058922OtherLICENSE