=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043596703
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NWI URGENT CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2011
-----------------------------------------------------
Last Update Date | 08/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8135 CALUMET AVE
-----------------------------------------------------
City | MUNSTER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-513-2000
-----------------------------------------------------
Fax | 219-513-2001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8135 CALUMET AVE
-----------------------------------------------------
City | MUNSTER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-513-2000
-----------------------------------------------------
Fax | 219-513-2001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CC SPECIALIST LEAD
-----------------------------------------------------
Name | JENNIFER BATY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 605-789-6574
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number | 01041056A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------