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NPI Code Detail

MEDICARE: 219 HEALTH NETWORK INC

MEDICARE: 219 HEALTH NETWORK INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1053963330
Entity Type Code : Organization
Provider Name (Legal Business Name) : 219 HEALTH NETWORK INC
Provider Business Mailing Address
First Line : 100 W CHICAGO AVE STE F
Second Line :
City : EAST CHICAGO
State : IN
Zip : 46312-3261
Country : US
Telephone Number : 219-365-7620
Fax Number : 219-226-2275
Provider Business Practice Location Address
First Line : 3432 169TH ST
Second Line :
City : HAMMOND
State : IN
Zip : 46323-2542
Country : US
Telephone Number : 219-844-9060
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : IBRAHIM MOHAMMED NAJAMUDDIN
Credential :
Telephone Number : 219-703-2585
Provider Enumeration Date : 07/16/2019
Last Update Date : 08/16/2024

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Directions to “219 HEALTH NETWORK INC ” Practice Location

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