Organization
NORTHSHORE HEALTH CENTERS, INC.
Active
Organization
NORTHSHORE HEALTH CENTERS, INC.
Active
Other names
NorthShore Chesterton Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID HALL (CEO)
(219) 763-8112
Entity
Organization
Contact information
Practice address
801 BROADWAY, CHESTERTON, IN 46304-2230
(219) 763-8112
(219) 763-8937
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-5380
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
111N00000X
Chiropractor
—
—
122300000X
Dentist
—
—
152W00000X
Optometrist
—
—
207Q00000X
Family Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151946
MEDICARE PART A PTAN
IN
01
—
191360
MEDICARE PART B PTAN
IN
05
—
200331170J
—
IN
Enumeration date
03/24/2015
Last updated
08/01/2022
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