Healthcare Provider Details

I. General information

NPI: 1932483377
Provider Name (Legal Business Name): NOVAMED SURGERY CENTER OF MERRILLVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8514 BROADWAY
MERRILLVILLE IN
46410-7032
US

IV. Provider business mailing address

1737 RELIABLE PKWY
CHICAGO IL
60686-3007
US

V. Phone/Fax

Practice location:
  • Phone: 219-756-5010
  • Fax: 219-756-5106
Mailing address:
  • Phone: 219-756-5010
  • Fax: 219-756-5106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MS. SUE GLASS
Title or Position: BILLING MANAGER
Credential:
Phone: 219-937-5067