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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