| |
5404 W 25th Ave Suite 107 Gary IN 46406-3141 | |
(219) 989-9759 | |
(219) 989-9757 |
Full Name | |
---|---|
Speciality | Clinic/center - Primary Care |
Location | 5404 W 25th Ave, Gary, Indiana |
Authorized Official Name and Position | Timothy Franklyn Gardner (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 2199899759 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
5404 W 25th Ave Suite 107 Gary IN 46406-3141 Ph: (219) 989-9759 | 5404 W 25th Ave Suite 107 Gary IN 46406-3141 Ph: (219) 989-9759 |
NPI Number | 1740470442 |
---|---|
Provider Enumeration Date | 07/28/2007 |
Last Update Date | 03/31/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740470442 | NPI | - | NPPES |
M400014630 | Other | IN | MEDICARE IDENTIFICATION NUMBER |
M100014629 | Other | IN | MEDICARE IDENTIFICATION NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 6600003-01 (Indiana) | Primary |
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 | |