Organization
ST MARGARET MERCY HEALTHCARE CENTERS, INC.
Active
Other names
Lowell Family Medical Services
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS GRYZBEK (PRESIDENT)
(219) 932-2300
Entity
Organization
Contact information
Practice address
2068 LUCAS PKWY, LOWELL, IN 46356-2169
(219) 696-8200
(219) 696-4917
Mailing address
PO BOX 1000, DYER, IN 46311-0800
(219) 864-2107
(219) 864-2251
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0090000854
BCBS GROUP NUMBER
IL
01
—
200159110E
MEDICAID
IN
Enumeration date
11/03/2006
Last updated
01/05/2010
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