Organization
NORTHSHORE HEALTH CENTERS, INC.
Active
Organization
NORTHSHORE HEALTH CENTERS, INC.
Active
Other names
NorthShore Griffith School Based Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID HALL (CEO)
(219) 763-8112
Entity
Organization
Contact information
Practice address
600 N WIGGS ST RM A104B, GRIFFITH, IN 46319-2060
(219) 763-8112
(219) 764-5380
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-5380
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
191360
MEDICARE PART B PTAN
IN
Enumeration date
05/14/2021
Last updated
05/14/2021
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