Organization
NORTHSHORE HEALTH CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANICE WILSON CEO (CEO)
(219) 763-8112
Entity
Organization
Contact information
Practice address
2490 CENTRAL AVE, LAKE STATION, IN 46405-2122
(219) 962-2760
(219) 962-1863
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-5384
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
03/16/2009
Last updated
03/16/2009
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