Full Name | |
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Speciality | Clinic/Center |
Location | 2200 Grant St, Gary, 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 |
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Po Box 1430 Portage IN 46368-9230 Ph: () - | 2200 Grant St Gary IN 46404-3439 Ph: (219) 763-8112 |
NPI Number | 1932976495 |
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Provider Enumeration Date | 12/05/2023 |
Last Update Date | 07/17/2024 |
Medicare PECOS PAC ID | 5799671236 |
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Medicare Enrollment ID | O20240705000111 |
Identifier | Type | State | Issuer |
---|---|---|---|
1932976495 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Ig Health & Vitality Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1325 Bigger St, Gary, IN 46404 Phone: 219-201-5597 | |
Premier Hospitalist Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 600 Grant St, Gary, IN 46402 Phone: 708-288-3452 Fax: 708-401-0050 | |
Comprehensive Safety, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7501 W 15th Ave, Gary, IN 46406 Phone: 219-977-2090 Fax: 219-977-2094 | |