MEDICARE: ST. MARGARET MERCY HEALTHCARE CENTERS INC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1609030469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARGARET MERCY HEALTHCARE CENTERS INC

Provider Business Mailing Address
First Line	:	PO BOX 1000
Second Line	:
City	:	DYER
State	:	IN
Zip	:	46311-0800
Country	:	US
Telephone Number	:	219-864-2107
Fax Number	:	219-864-2251

Provider Business Practice Location Address
First Line	:	19400 NORTH CREEK DRIVE
Second Line	:
City	:	LYNWOOD
State	:	IL
Zip	:	60411-8742
Country	:	US
Telephone Number	:	708-474-0410
Fax Number	:	708-474-0328

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS GRYZBEK
Credential	:
Telephone Number	:	219-932-2300

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	01/06/2010

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