Healthcare Provider Details

I. General information

NPI: 1982771267
Provider Name (Legal Business Name): ST MARGARET MERCY HEALTHCARE CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 HOHMAN AVE
HAMMOND IN
46320-1931
US

IV. Provider business mailing address

PO BOX 1000
DYER IN
46311-0800
US

V. Phone/Fax

Practice location:
  • Phone: 219-933-7930
  • Fax: 219-933-2655
Mailing address:
  • Phone: 219-864-2107
  • Fax: 219-864-2251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS GRYZBEK
Title or Position: PRESIDENT
Credential:
Phone: 219-932-2300