Organization
BROADWEST SPECIALTY SURGICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIJAY K. GUPTA M.D. (PRESIDENT/CEO)
(219) 757-5275
Entity
Organization
Contact information
Practice address
315 W 89TH AVENUE, MERRILLVILLE, IN 46410-6254
(219) 757-5275
(219) 757-5292
Mailing address
315 W 89TH AVENUE, MERRILLVILLE, IN 46410-6254
(219) 757-5275
(219) 757-5292
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
05/10/2006
Last updated
07/01/2015
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