Organization
NORTHSHORE HEALTH CENTERS, INC
Active
Organization
NORTHSHORE HEALTH CENTERS, INC
Active
Other names
NorthShore Hammond Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID HALL (CEO)
(219) 763-8112
Entity
Organization
Contact information
Practice address
1828 165TH ST STE A, HAMMOND, IN 46320-2823
(219) 763-8112
(219) 844-9006
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-5380
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
111N00000X
Chiropractor
—
—
1223G0001X
General Practice Dentistry
—
—
124Q00000X
Dental Hygienist
—
—
207Q00000X
Family Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151912
MEDICARE PART A PTAN
IN
01
—
191360
MEDICARE PART B PTAN
IN
05
—
200331170H
—
IN
Enumeration date
08/07/2013
Last updated
02/03/2021
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