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General NPI Number Information
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NPI Number | 1235160938
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Entity Type | Organization
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Legal Business Name | IMA ENDOSCOPY SURGICENTER P C
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 8895 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7037
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Country | US
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Telephone | 219-738-2081
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Fax |
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Provider Business Mailing Address
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Address Line | 8895 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7037
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Country | US
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Telephone | 219-738-2081
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL HURWICH
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Credential | MD
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Telephone | 219-738-2724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | 50003667A
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License Number State | IN
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