Organization
METHODIST HOSPITALS PATHOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IAN E MCFADDEN (PRESIDENT/CEO)
(219) 886-4171
Entity
Organization
Contact information
Practice address
600 GRANT ST, GARY, IN 46402-6001
(219) 886-4573
Mailing address
PO BOX 660267, INDIANAPOLIS, IN 46266-0001
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200804900A
—
IN
05
—
200804900B
—
IN
01
—
DE3998
RAILROAD MEDICARE
—
Enumeration date
01/26/2006
Last updated
02/06/2009
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