Organization
ST MARGARET MERCY HEALTHCARE CENTERS, INC
Active
Other names
Ear Nose and Throat Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER MAPLE (CONTROLLER)
(219) 932-2300
Entity
Organization
Contact information
Practice address
24 JOLIET ST STE 101, DYER, IN 46311-1705
(219) 864-2059
(219) 864-2644
Mailing address
PO BOX 1000, DYER, IN 46311-0800
(219) 864-2268
(219) 864-2649
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
02000967A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200504980
—
IN
Enumeration date
01/06/2010
Last updated
01/06/2010
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