Organization
INDIANA UNIVERSITY HEALTH LAKESHORE SURGICARE LLC
Active
Other names
CNI SURGICARE LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GUDSTEINN T THORDARSON N/A (PRESIDENT)
(219) 326-2555
Entity
Organization
Contact information
Practice address
3111 VILLAGE POINTE, CHESTERTON, IN 46304-9689
(219) 983-1401
(219) 929-1408
Mailing address
3111 VILLAGE POINTE, CHESTERTON, IN 46304-9689
(219) 983-1401
(219) 929-1408
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
13-011186-1
IN
261QA1903X
Ambulatory Surgical Clinic/Center
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10-011186-1
ASC LICENSE
IN
05
—
200990180 A
—
IN
01
—
M300021861
MEDICARE PTAN
IN
Enumeration date
03/31/2010
Last updated
08/07/2013
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