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General NPI Number Information
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NPI Number | 1801975438
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Entity Type | Organization
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Legal Business Name | ST MARGARET MERCY HEALTHCARE CENTERS, INC.
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 2001 E COLUMBUS DR SUITE # C
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City | EAST CHICAGO
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State | IN
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Zip | 46312-2829
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Country | US
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Telephone | 219-933-2623
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Fax | 219-378-9283
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Provider Business Mailing Address
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Address Line | PO BOX 1000
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City | DYER
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State | IN
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Zip | 46311-0800
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Country | US
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Telephone | 219-864-2107
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Fax | 219-864-2251
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS GRYZBEK
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Credential |
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Telephone | 219-932-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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