Healthcare Provider Details

I. General information

NPI: 1093213506
Provider Name (Legal Business Name): 219 HEALTH NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CHICAGO AVE STE F
EAST CHICAGO IN
46312-3261
US

IV. Provider business mailing address

100 W CHICAGO AVE STE F
EAST CHICAGO IN
46312-3261
US

V. Phone/Fax

Practice location:
  • Phone: 219-392-7016
  • Fax:
Mailing address:
  • Phone: 219-392-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM CORTES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 219-703-2585