| Edgewater Health: Lake Street Pediatrics | |
|
426 S Lake St Gary IN 46403-2405 | |
| (219) 939-6070 | |
| Not Available |
| Full Name | Edgewater Health: Lake Street Pediatrics |
|---|---|
| Speciality | Clinic/Center |
| Location | 426 S Lake St, Gary, Indiana |
| Authorized Official Name and Position | Danita Johnson Hughes (CEO) |
| Authorized Official Contact | 2198854264 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edgewater Health: Lake Street Pediatrics 1100 W 6th Ave Gary IN 46402-1711 Ph: (219) 885-4264 | Edgewater Health: Lake Street Pediatrics 426 S Lake St Gary IN 46403-2405 Ph: (219) 939-6070 |
| NPI Number | 1245907344 |
|---|---|
| Provider Enumeration Date | 08/26/2021 |
| Last Update Date | 08/26/2021 |
| Medicare PECOS PAC ID | 9234398397 |
|---|---|
| Medicare Enrollment ID | O20210902000571 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245907344 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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