# UCHICAGO MEDICINE NORTHWEST INDIANA INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306525837
- **Authorized official:** NICOLE FOUNTAIN (VP REVENUE CYCLE)
- **Authorized official phone:** (773) 834-5895

## Contact information

- **Practice address:** 10855 VIRGINIA ST STE 1200, CROWN POINT, IN 46307-0210
- **Practice address phone:** (999) 999-9999
- **Mailing address:** 150 HARVESTER DR STE 300, BURR RIDGE, IL 60527-5965
- **Mailing address phone:** (773) 795-7807

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/12/2023
- **Last updated:** 01/23/2025