Healthcare Provider Details

I. General information

NPI: 1336384882
Provider Name (Legal Business Name): ST MARGARET MERCY HEALTHCARE CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1573 N CLINE AVE
GRIFFITH IN
46319-1567
US

IV. Provider business mailing address

PO BOX 1000
DYER IN
46311-0800
US

V. Phone/Fax

Practice location:
  • Phone: 219-972-7179
  • Fax: 219-972-7183
Mailing address:
  • Phone: 219-864-2268
  • Fax: 219-864-2649

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: 219-932-8300