Organization
NORTHSHORE HEALTH CENTERS INC
Active
Organization
NORTHSHORE HEALTH CENTERS INC
Active
Other names
NorthShore Regional Health Centers
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANICE WILSON (CEO)
(219) 763-8112
Entity
Organization
Contact information
Practice address
8555 TAFT ST, MERRILLVILLE, IN 46410-6123
(219) 763-8112
(219) 764-3251
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-3251
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151861
MEDICARE PTAN
IN
01
—
191360
MEDICARE PART B PTAN
IN
05
—
200331170
—
IN
Enumeration date
01/11/2010
Last updated
03/12/2013
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