Organization
ST MARGARET MERCY HEALTHCARE CENTERS, INC.
Active
Other names
Physician Outpatient Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS GRYZBEK (PRESIDENT)
(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) 864-2107
(219) 864-2251
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0090000854
BCBS GROUP NUMBER
IL
05
—
200159110Z
—
IN
Enumeration date
11/15/2006
Last updated
01/05/2010
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