Provider Demographics
NPI: | 1336384882 |
---|---|
Name: | ST MARGARET MERCY HEALTHCARE CENTERS |
Entity Type: | Organization |
Organization Name: | ST MARGARET MERCY HEALTHCARE CENTERS |
Other - Org Name: | FRANCISCAN EXPRESS CARE-GRIFFITH |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | THOMAS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GRYZBEK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 219-932-8300 |
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: | 1573 N CLINE AVE |
Practice Address - Street 2: | |
Practice Address - City: | GRIFFITH |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46319-1567 |
Practice Address - Country: | US |
Practice Address - Phone: | 219-972-7179 |
Practice Address - Fax: | 219-972-7183 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-12-12 |
Last Update Date: | 2008-12-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty |