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General NPI Number Information
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NPI Number | 1477810315
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Entity Type | Organization
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Legal Business Name | NORTHSHORE HEALTH CENTERS, INC.
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Dates
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Enumeration Date | 04/17/2012
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 6091 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-2619
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Country | US
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Telephone | 219-763-8112
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Fax | 219-884-2547
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Provider Business Mailing Address
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Address Line | PO BOX 1430
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City | PORTAGE
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State | IN
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Zip | 46368-9230
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Country | US
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Telephone | 219-763-8112
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Fax | 219-764-5380
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Authorized Official
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Title or Position | CEO
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Name | DAVID HALL
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Credential |
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Telephone | 219-763-8112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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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 | 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 #5
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #9
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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 #10
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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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