Healthcare Provider Details

I. General information

NPI: 1821771874
Provider Name (Legal Business Name): 219 HEALTH NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1946 45TH ST STE D
MUNSTER IN
46321-3986
US

IV. Provider business mailing address

100 W CHICAGO AVE STE F
EAST CHICAGO IN
46312-3261
US

V. Phone/Fax

Practice location:
  • Phone: 219-924-1888
  • Fax: 219-922-8359
Mailing address:
  • Phone: 219-392-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM CORTES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 219-703-2585