Organization
SOUTHEASTERN MEDICAL CENTER S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAJEEV BHAREL (NETWORK ADMINISTRATOR)
(219) 933-4889
Entity
Organization
Contact information
Practice address
4020 S CALUMET AVE, HAMMOND, IN 46320-1129
(219) 933-4889
(219) 933-3153
Mailing address
PO BOX 704, HAMMOND, IN 46325-0704
(219) 933-4889
(219) 933-3153
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01031453A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000105624
BLUE CROSS OF IN
IN
01
—
0090001298
BCBS IL
IL
05
—
100214150A
—
IN
Enumeration date
03/23/2007
Last updated
10/13/2015
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