| Grand Park Surgical Center, Inc | |
|
1479 E 84th Pl Merrillville IN 46410-6451 | |
| (219) 738-2828 | |
| (219) 756-3349 |
| Full Name | Grand Park Surgical Center, Inc |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1479 E 84th Pl, Merrillville, Indiana |
| Authorized Official Name and Position | Lucy T Morales (C.E.O.) |
| Authorized Official Contact | 2197382828 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Park Surgical Center, Inc 1479 E 84th Pl Merrillville IN 46410-6451 Ph: (219) 738-2828 | Grand Park Surgical Center, Inc 1479 E 84th Pl Merrillville IN 46410-6451 Ph: (219) 738-2828 |
| NPI Number | 1568525244 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 04/28/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568525244 | NPI | - | NPPES |
| 000000098072 | Other | IN | BLUECROSSBLUESHIELD |
| 100274590A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 060062141 (Indiana) | Primary |
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