Provider Demographics
NPI:1841273232
Name:WOMEN'S SPECIALIST OF NORTHWEST INDIANA, LLC
Entity type:Organization
Organization Name:WOMEN'S SPECIALIST OF NORTHWEST INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-397-2008
Mailing Address - Street 1:3924-26 MAIN ST.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312
Mailing Address - Country:US
Mailing Address - Phone:219-397-2008
Mailing Address - Fax:219-398-1339
Practice Address - Street 1:3924-26 MAIN ST.
Practice Address - Street 2:SUITE 202
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312
Practice Address - Country:US
Practice Address - Phone:219-397-2008
Practice Address - Fax:219-398-1339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036148A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200501220AMedicaid
IL377621358Medicaid
IN199410Medicare ID - Type UnspecifiedGROUP MEDICARE ID#
IN200501220AMedicaid