Provider Demographics
NPI:1972818649
Name:ST. MARGARET MERCY HEALTHCARE CENTERS INC
Entity Type:Organization
Organization Name:ST. MARGARET MERCY HEALTHCARE CENTERS INC
Other - Org Name:MUNSTER SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-864-5296
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-0800
Mailing Address - Country:US
Mailing Address - Phone:219-864-2268
Mailing Address - Fax:219-864-2649
Practice Address - Street 1:8230 CALUMET AVE
Practice Address - Street 2:STE 110 FRONT
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1753
Practice Address - Country:US
Practice Address - Phone:219-836-6161
Practice Address - Fax:219-836-6205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026156A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty