Healthcare Provider Details

I. General information

NPI: 1174851885
Provider Name (Legal Business Name): NORTH AMERICAN HEALTH SYSTEMS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SUPERIOR AVE STE J
MUNSTER IN
46321-4038
US

IV. Provider business mailing address

701 SUPERIOR AVE STE J
MUNSTER IN
46321-4038
US

V. Phone/Fax

Practice location:
  • Phone: 219-934-9399
  • Fax: 219-934-9479
Mailing address:
  • Phone: 219-934-9399
  • Fax: 219-934-9479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number01027712A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number01027712A
License Number StateIN

VIII. Authorized Official

Name: RUTH H BAKER
Title or Position: BILLING MANAGER
Credential:
Phone: 219-934-9399