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General NPI Number Information
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NPI Number | 1568525244
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Entity Type | Organization
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Legal Business Name | GRAND PARK SURGICAL CENTER, INC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 04/28/2014
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Provider Practice Location Address
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Address Line | 1479 E 84TH PL
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6451
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Country | US
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Telephone | 219-738-2828
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Fax | 219-756-3349
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Provider Business Mailing Address
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Address Line | 1479 E 84TH PL
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6451
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Country | US
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Telephone | 219-738-2828
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Fax | 219-756-3349
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Authorized Official
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Title or Position | C.E.O.
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Name | MS. LUCY T MORALES
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Credential | R.N.
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Telephone | 219-738-2828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 060062141
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License Number State | IN
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