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General NPI Number Information
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NPI Number | 1740482751
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Entity Type | Organization
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Legal Business Name | MERRIVILLE PLAZA SURGERY CENTER
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 255 E 90TH DR
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City | MERRILLVILLE BRA
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State | IN
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Zip | 46410-8103
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Country | US
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Telephone | 219-791-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 255 E 90TH DR
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City | MERRILLVILLE BRA
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State | IN
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Zip | 46410-8103
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Country | US
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Telephone | 219-791-0500
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. ANITA NAYAK
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Credential |
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Telephone | 219-791-0500
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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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