Organization
ST MARGARET MERCY HEALTHCARE CENTERS
Active
Other names
St John Family Services
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS GRYZBEK (PRESIDENT)
(219) 932-2300
Entity
Organization
Contact information
Practice address
10860 MAPLE LN, SAINT JOHN, IN 46373-8418
(219) 365-7000
(219) 365-2609
Mailing address
PO BOX 1000, DYER, IN 46311-0800
(219) 365-7000
(219) 365-2609
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0090000854
BCBS GROUP NUMBER
IL
05
—
200159110Y
—
IN
Enumeration date
11/29/2006
Last updated
01/05/2010
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