# BROADWEST SPECIALTY SURGICAL CENTER, LLC

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

## Provider details

- **NPI number:** 1770532194
- **Authorized official:** VIJAY K. GUPTA M.D. (PRESIDENT/CEO)
- **Authorized official phone:** (219) 757-5275

## Contact information

- **Practice address:** 315 W 89TH AVENUE, MERRILLVILLE, IN 46410-6254
- **Practice address phone:** (219) 757-5275
- **Practice address fax:** (219) 757-5292
- **Mailing address:** 315 W 89TH AVENUE, MERRILLVILLE, IN 46410-6254
- **Mailing address phone:** (219) 757-5275
- **Mailing address fax:** (219) 757-5292

## Taxonomy

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

## Other

- **Enumeration date:** 05/10/2006
- **Last updated:** 07/01/2015