Organization
ST MARGARET MERCY HEALTHCARE CENTERS
Active
Other names
Dyer Family Practice South
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS GRYZBEK (PRESIDENT)
(219) 932-2300
Entity
Organization
Contact information
Practice address
14785 W 101ST AVE, DYER, IN 46311-3371
(219) 864-2235
(219) 864-1398
Mailing address
PO BOX 1000, DYER, IN 46311-0800
(219) 864-2107
(219) 864-2649
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0090000854
BCBS GROUP NUMBER
IL
05
—
200159110I
—
IN
Enumeration date
11/09/2006
Last updated
06/23/2010
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