| Northshore Edison Senior High School | |
|
3304 Parkside Ave Lake Station IN 46405-1143 | |
| (219) 763-8112 | |
| (219) 962-1860 |
| Full Name | Northshore Edison Senior High School |
|---|---|
| Speciality | Clinic/Center |
| Location | 3304 Parkside Ave, Lake Station, Indiana |
| Authorized Official Name and Position | David Hall (CEO) |
| Authorized Official Contact | 2197638112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northshore Edison Senior High School Po Box 1430 Portage IN 46368-9230 Ph: (219) 763-8112 | Northshore Edison Senior High School 3304 Parkside Ave Lake Station IN 46405-1143 Ph: (219) 763-8112 |
| NPI Number | 1972895647 |
|---|---|
| Provider Enumeration Date | 05/12/2011 |
| Last Update Date | 09/22/2020 |
| Medicare PECOS PAC ID | 5799671236 |
|---|---|
| Medicare Enrollment ID | O20110817000200 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972895647 | NPI | - | NPPES |
| 191360 | Other | IN | MEDICARE PART B PTAN |
| 151874 | Other | IN | MEDICARE PART A PTAN |
| 200331170F | Medicaid | IN |
Fernando H. Rivera M.d. Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3099 Central Ave, Lake Station, IN 46405 Phone: 219-962-1418 Fax: 219-962-4516 | |
Northshore Health Centers, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2490 Central Ave Ste B, Lake Station, IN 46405 Phone: 219-962-5909 Fax: 219-962-5981 |