Healthcare Provider Details

I. General information

NPI: 1548629181
Provider Name (Legal Business Name): CHESTERTON SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 VILLAGE PT
CHESTERTON IN
46304-9689
US

IV. Provider business mailing address

3111 VILLAGE PT
CHESTERTON IN
46304-9689
US

V. Phone/Fax

Practice location:
  • Phone: 219-983-1401
  • Fax: 219-929-1408
Mailing address:
  • Phone: 219-983-1401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTY MUSIC
Title or Position: AO-DIRECTOR PROVIDER ENROLLMENT
Credential:
Phone: 615-465-7377