Healthcare Provider Details

I. General information

NPI: 1669521183
Provider Name (Legal Business Name): ST. MARGARET MERCY HEALTHCARE CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8242 CALUMET AVENUE
MUNSTER IN
46321-1704
US

IV. Provider business mailing address

PO BOX 1000
DYER IN
46311-0800
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-6166
  • Fax:
Mailing address:
  • Phone: 219-864-2107
  • Fax: 219-864-2649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01026776A
License Number StateIN

VIII. Authorized Official

Name: THOMAS GRYZBEK
Title or Position: PRESIDENT
Credential:
Phone: 219-933-2300