Provider Demographics
NPI:1700189511
Name:METHODIST HOSPITALS SPINE CARE CENTER
Entity Type:Organization
Organization Name:METHODIST HOSPITALS SPINE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:219-886-4432
Mailing Address - Street 1:200 E 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7318
Mailing Address - Country:US
Mailing Address - Phone:219-738-4930
Mailing Address - Fax:219-738-4931
Practice Address - Street 1:200 E 89TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7318
Practice Address - Country:US
Practice Address - Phone:219-738-4930
Practice Address - Fax:219-738-4931
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METHODIST HOSPITALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28085181A282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital