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General NPI Number Information
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NPI Number | 1134802135
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Entity Type | Organization
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Legal Business Name | 219 HEALTH NETWORK, INC.
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 10215 BROADWAY STE 204
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City | CROWN POINT
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State | IN
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Zip | 46307-8001
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Country | US
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Telephone | 219-661-6152
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Fax | 219-703-6833
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Provider Business Mailing Address
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Address Line | 100 W CHICAGO AVE STE F
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City | EAST CHICAGO
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State | IN
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Zip | 46312-3261
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Country | US
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Telephone | 219-392-7016
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | WILLIAM CORTES
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Credential |
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Telephone | 219-703-2585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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