| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 4022 Hohman Ave, Hammond, Indiana |
| Authorized Official Name and Position | Robert Krumwied (CEO) |
| Authorized Official Contact | 2197367183 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8400 Louisiana St Merrillville IN 46410-6385 Ph: (219) 757-1924 | 4022 Hohman Ave Hammond IN 46327 Ph: (219) 937-3300 |
| NPI Number | 1609231927 |
|---|---|
| Provider Enumeration Date | 12/31/2015 |
| Last Update Date | 07/01/2016 |
| Medicare PECOS PAC ID | 5991600355 |
|---|---|
| Medicare Enrollment ID | O20160318001142 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609231927 | NPI | - | NPPES |
| 15D2108285 | Other | IN | CLIA |
| 201323280 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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