| Indiana Sports & Medical Science Institute, Pc | |
|
11275 Delaware Pkwy Ste A Crown Point IN 46307-7812 | |
| (219) 779-8735 | |
| (877) 715-2312 |
| Full Name | Indiana Sports & Medical Science Institute, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11275 Delaware Pkwy Ste A, Crown Point, Indiana |
| Authorized Official Name and Position | Timothy James Mullaly (OWNER) |
| Authorized Official Contact | 8108142661 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indiana Sports & Medical Science Institute, Pc Po Box 108 Crown Point IN 46308-0108 Ph: (219) 662-5530 | Indiana Sports & Medical Science Institute, Pc 11275 Delaware Pkwy Ste A Crown Point IN 46307-7812 Ph: (219) 779-8735 |
| NPI Number | 1609155290 |
|---|---|
| Provider Enumeration Date | 08/12/2011 |
| Last Update Date | 07/11/2022 |
| Medicare PECOS PAC ID | 2860662517 |
|---|---|
| Medicare Enrollment ID | O20110907001110 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609155290 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 02003099A (Indiana) | Primary |
| Provider Name | Timothy J Mullally |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366462046 PECOS PAC ID: 6709885171 Enrollment ID: I20061212000525 |
| Provider Name | Lisa D Mullally |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861462012 PECOS PAC ID: 3274568332 Enrollment ID: I20070330000401 |
| Provider Name | Colleen M Lustina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346576998 PECOS PAC ID: 7911298211 Enrollment ID: I20160616000966 |
| Provider Name | Julie A Mallers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396913646 PECOS PAC ID: 1759672017 Enrollment ID: I20160617000394 |
| Provider Name | Kunteera Vachirasomboon Tarin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740411305 PECOS PAC ID: 1355496712 Enrollment ID: I20171003005151 |
Jab Sports Medicine & Direct Primary Care Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5521 W Lincoln Hwy Ste 230, Crown Point, IN 46307 Phone: 219-301-1158 Fax: 219-301-1158 | |
The Good Doctor, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 952 S Court St, Crown Point, IN 46307 Phone: 219-226-0650 Fax: 219-226-0618 | |
219 Health Network, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 10215 Broadway Ste 204, Crown Point, IN 46307 Phone: 219-661-6152 Fax: 219-703-6833 | |
Elite Diagnostics Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 10996 Four Seasons Pl, Ste 100a, Crown Point, IN 46307 Phone: 888-339-7339 Fax: 312-254-1421 | |
Prestige 2 Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 11360 Broadway, Crown Point, IN 46307 Phone: 219-301-2624 | |
Hospice Of America, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1229 Arrowhead Ct, Crown Point, IN 46307 Phone: 219-661-3100 | |
Pinnacle Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9301 Connecticut Dr, Crown Point, IN 46307 Phone: 219-796-4150 |