Healthcare Provider Details

I. General information

NPI: 1558440149
Provider Name (Legal Business Name): ST MARGARET MERCY HEALTHCARE CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 S HOHMAN AVE
HAMMOND IN
46327-1160
US

IV. Provider business mailing address

PO BOX 1000
DYER IN
46311-0800
US

V. Phone/Fax

Practice location:
  • Phone: 219-931-1960
  • Fax: 219-931-1235
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