Healthcare Provider Details

I. General information

NPI: 1215201868
Provider Name (Legal Business Name): FRANCISCAN HAMMOND CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 VALPARAISO COURT
MUNSTER IN
46321-4040
US

IV. Provider business mailing address

7905 CALUMET AVE
MUNSTER IN
46321-2549
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-5800
  • Fax: 219-836-8073
Mailing address:
  • Phone: 219-836-5800
  • Fax: 219-836-8073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01032154
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01052057
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01061659
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number01066795
License Number StateIN

VIII. Authorized Official

Name: MRS. BEVERLY DELAO
Title or Position: ADMINISTRATOR
Credential:
Phone: 219-836-5800