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General NPI Number Information
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NPI Number | 1043626443
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Entity Type | Organization
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Legal Business Name | LAKE COUNTY JAIL
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 2293 N MAIN ST
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City | CROWN POINT
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State | IN
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Zip | 46307-1854
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Country | US
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Telephone | 219-648-6300
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Fax | 219-755-3427
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Provider Business Mailing Address
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Address Line | 2293 N MAIN ST
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City | CROWN POINT
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State | IN
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Zip | 46307-1854
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Country | US
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Telephone | 219-648-6300
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Fax | 219-755-3427
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | WILLIAM WALLACE FORGEY
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Credential | M.D.
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Telephone | 219-755-3385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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