Provider Demographics
NPI:1740406602
Name:INSTITUTE OF FAMILY HEALTH
Entity Type:Organization
Organization Name:INSTITUTE OF FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:S
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-798-4664
Mailing Address - Street 1:5454 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-1648
Mailing Address - Country:US
Mailing Address - Phone:219-884-2600
Mailing Address - Fax:219-985-0570
Practice Address - Street 1:5454 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-884-2600
Practice Address - Fax:219-985-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026604A146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100168290Medicaid
IN100168290Medicaid