Healthcare Provider Details

I. General information

NPI: 1700189511
Provider Name (Legal Business Name): METHODIST HOSPITALS SPINE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 89TH AVE
MERRILLVILLE IN
46410-7318
US

IV. Provider business mailing address

8701 BROADWAY
MERRILLVILLE IN
46410-7035
US

V. Phone/Fax

Practice location:
  • Phone: 219-738-4930
  • Fax: 219-738-4931
Mailing address:
  • Phone: 219-738-5985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number28085181A
License Number StateIN

VIII. Authorized Official

Name: MR. MATT DOYLE
Title or Position: CEO
Credential:
Phone: 219-738-5985