Edgewater Health - Merrillville | |
5495 Broadway Merrillville IN 46410-1647 | |
(219) 985-5500 | |
Not Available |
Full Name | Edgewater Health - Merrillville |
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Speciality | Clinic/Center |
Location | 5495 Broadway, Merrillville, 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 |
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Edgewater Health - Merrillville 1100 W 6th Ave Gary IN 46402-1711 Ph: (219) 885-4264 | Edgewater Health - Merrillville 5495 Broadway Merrillville IN 46410-1647 Ph: (219) 985-5500 |
NPI Number | 1407457591 |
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Provider Enumeration Date | 11/04/2020 |
Last Update Date | 09/01/2023 |
Medicare PECOS PAC ID | 9234398397 |
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Medicare Enrollment ID | O20201214000637 |
Identifier | Type | State | Issuer |
---|---|---|---|
1407457591 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
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