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General NPI Number Information
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NPI Number | 1952514895
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Entity Type | Organization
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Legal Business Name | SACRIS MEDICAL CORPORATION PC
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 2000 ROOSEVELT RD SUITE 207
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City | VALPARAISO
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State | IN
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Zip | 46383-2800
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Country | US
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Telephone | 219-462-4042
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Fax | 219-462-1444
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Provider Business Mailing Address
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Address Line | PO BOX 1338
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City | VALPARAISO
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State | IN
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Zip | 46384-1338
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Country | US
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Telephone | 219-462-4042
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Fax | 219-462-1444
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. MICHAEL H DELA VINA
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Credential |
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Telephone | 219-462-4042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician
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License Number | 01025728
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License Number State | IN
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