Healthcare Provider Details

I. General information

NPI: 1730956194
Provider Name (Legal Business Name): BANDY FAMILY HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 09/27/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 BROADWAY
GARY IN
46409-1316
US

IV. Provider business mailing address

9357 MICHIGAN DR
CROWN POINT IN
46307-6522
US

V. Phone/Fax

Practice location:
  • Phone: 219-331-8330
  • Fax:
Mailing address:
  • Phone: 219-331-8330
  • Fax: 219-413-5245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE SPENCER BANDY
Title or Position: CEO
Credential: FNP
Phone: 219-331-8330