Organization
NORTHSHORE HEALTH CENTERS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID HALL (CEO)
(219) 763-8112
Entity
Organization
Contact information
Practice address
2490 CENTRAL AVE, LAKE STATION, IN 46405-2122
(219) 763-8112
(219) 962-1580
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-5380
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
152W00000X
Optometrist
—
—
207Q00000X
Family Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151846
MEDICARE PART A PTAN
IN
01
—
191360
MEDICARE PART B PTAN
IN
05
—
200331170D
—
IN
Enumeration date
04/23/2009
Last updated
11/12/2020
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