Full Name | |
---|---|
Speciality | Family Medicine |
Location | 600 Grant St, Gary, Indiana |
Authorized Official Name and Position | Crystal Hunt (BILLING MANAGER) |
Authorized Official Contact | 2192018178 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1024 Killarney Dr Dyer IN 46311-1293 Ph: () - | 600 Grant St Gary IN 46402-6001 Ph: (219) 201-8178 |
NPI Number | 1174030605 |
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Provider Enumeration Date | 01/05/2018 |
Last Update Date | 03/18/2024 |
Medicare PECOS PAC ID | 0840559654 |
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Medicare Enrollment ID | O20180123002691 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174030605 | NPI | - | NPPES |
1003724508 | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 01038347 (Kansas) | Primary |
Provider Name | David D Chube |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1124024096 PECOS PAC ID: 9335406172 Enrollment ID: I20171201002372 |
Ig Health & Vitality Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1325 Bigger St, Gary, IN 46404 Phone: 219-201-5597 | |
Premier Hospitalist Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 600 Grant St, Gary, IN 46402 Phone: 708-288-3452 Fax: 708-401-0050 | |
Comprehensive Safety, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7501 W 15th Ave, Gary, IN 46406 Phone: 219-977-2090 Fax: 219-977-2094 | |