Organization
ST MARGARET MERCY HEALTHCARE CENTERS, INC.
Active
Other names
Lake Ridge Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS GRYZBEK (PRESIDENT)
(219) 932-2300
Entity
Organization
Contact information
Practice address
1573 N CLINE AVE, GRIFFITH, IN 46319-1567
(219) 383-2311
(219) 838-1521
Mailing address
PO BOX 1000, DYER, IN 46311-0800
(219) 864-2107
(219) 864-2251
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0090000854
BCBS GROUP NUMBER
IL
05
—
200159110C
—
IN
Enumeration date
11/03/2006
Last updated
06/23/2008
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