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General NPI Number Information
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NPI Number | 1548629181
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Entity Type | Organization
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Legal Business Name | CHESTERTON SURGERY CENTER LLC
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 3111 VILLAGE PT
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City | CHESTERTON
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State | IN
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Zip | 46304-9689
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Country | US
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Telephone | 219-983-1401
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Fax | 219-929-1408
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Provider Business Mailing Address
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Address Line | 3111 VILLAGE PT
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City | CHESTERTON
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State | IN
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Zip | 46304-9689
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Country | US
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Telephone | 219-983-1401
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Fax |
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Authorized Official
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Title or Position | AO-DIRECTOR PROVIDER ENROLLMENT
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Name | KRISTY MUSIC
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Credential |
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Telephone | 615-465-7377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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