Organization
GRAND PARK SURGICAL CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LUCY T MORALES R.N. (C.E.O.)
(219) 738-2828
Entity
Organization
Contact information
Practice address
1479 E 84TH PL, MERRILLVILLE, IN 46410-6451
(219) 738-2828
(219) 756-3349
Mailing address
1479 E 84TH PL, MERRILLVILLE, IN 46410-6451
(219) 738-2828
(219) 756-3349
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
060062141
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000098072
BLUECROSSBLUESHIELD
IN
05
—
100274590A
—
IN
Enumeration date
12/18/2006
Last updated
04/28/2014
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