Healthcare Provider Details

I. General information

NPI: 1609030469
Provider Name (Legal Business Name): ST. MARGARET MERCY HEALTHCARE CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19400 NORTH CREEK DRIVE
LYNWOOD IL
60411-8742
US

IV. Provider business mailing address

PO BOX 1000
DYER IN
46311-0800
US

V. Phone/Fax

Practice location:
  • Phone: 708-474-0410
  • Fax: 708-474-0328
Mailing address:
  • Phone: 219-864-2107
  • Fax: 219-864-2251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS GRYZBEK
Title or Position: PRESIDENT
Credential:
Phone: 219-932-2300