Provider Demographics
NPI:1942303870
Name:AMERICAN MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:AMERICAN MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDYARD
Authorized Official - Middle Name:U
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-937-9653
Mailing Address - Street 1:539 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2951
Mailing Address - Country:US
Mailing Address - Phone:773-459-9661
Mailing Address - Fax:219-937-2981
Practice Address - Street 1:9250 COLUMBIA AVE STE 1F
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3530
Practice Address - Country:US
Practice Address - Phone:219-937-9653
Practice Address - Fax:219-937-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15D1025134OtherCLIA
IN200145800Medicaid