MEDICARE: NWI PATIENT CARE LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine
2	174400000X	Specialist	01026604A	IN

General Provider Information

NPI Number	:	1114228723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NWI PATIENT CARE LLC.

Provider Business Mailing Address
First Line	:	5925 E. MELTON RD.
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46403-4020
Country	:	US
Telephone Number	:	219-939-8745
Fax Number	:	219-939-8748

Provider Business Practice Location Address
First Line	:	544 S LAKE ST
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46403-2473
Country	:	US
Telephone Number	:	219-939-8745
Fax Number	:	219-939-8748

Authorized Official
Title or Position	:	CFO-OWNER
Name	:	MRS. JENNIE S. TEAGUE
Credential	:
Telephone Number	:	219-939-8745

Provider Enumeration Date	:	11/12/2010
Last Update Date	:	09/05/2014

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Directions to “NWI PATIENT CARE LLC. ” Practice Location

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