| |
1313 W Chicago Ave East Chicago IN 46312 | |
(219) 398-9685 | |
(219) 398-9695 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1313 W Chicago Ave, East Chicago, Indiana |
Authorized Official Name and Position | Melissa Mitchell (CEO) |
Authorized Official Contact | 2194659503 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2401 Valley Dr Valparaiso IN 46383-2520 Ph: (219) 413-5100 | 1313 W Chicago Ave East Chicago IN 46312 Ph: (219) 398-9685 |
NPI Number | 1184069569 |
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Provider Enumeration Date | 04/30/2013 |
Last Update Date | 01/12/2024 |
Medicare PECOS PAC ID | 7618929373 |
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Medicare Enrollment ID | O20130612000594 |
Identifier | Type | State | Issuer |
---|---|---|---|
1184069569 | NPI | - | NPPES |
200317310F | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | H80CS06662 (Indiana) | Primary |
219 Health Network, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4320 Fir St Unit 216, East Chicago, IN 46312 Phone: 219-392-7025 | |
219 Health Network Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1802 E Columbus Dr, East Chicago, IN 46312 Phone: 219-397-6916 Fax: 219-397-9313 | |
Nwi Home Doctor Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3847 Euclid Ave, East Chicago, IN 46312 Phone: 219-949-7540 | |
219 Health Network Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 100 W Chicago Ave Ste F, East Chicago, IN 46312 Phone: 219-392-7016 | |