MEDICARE: NORTHWEST PROCEDURES MEDICAL CENTER AND IMMEDIATE CARE CENTERS

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
1	261Q00000X	Clinic/Center	01043017A	IN

General Provider Information

NPI Number	:	1942321294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST PROCEDURES MEDICAL CENTER AND IMMEDIATE CARE CENTERS

Provider Business Mailing Address
First Line	:	3814 GRANT ST
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46408-2150
Country	:	US
Telephone Number	:	219-397-1951
Fax Number	:	219-397-2668

Provider Business Practice Location Address
First Line	:	2010 E COLUMBUS DR
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-2830
Country	:	US
Telephone Number	:	219-397-1951
Fax Number	:	219-397-2668

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GEOFFREY OKECHUKWU ONYEUKWU
Credential	:	MD
Telephone Number	:	219-884-3447

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	06/30/2008

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