| NPI | 1265148498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA JOHNSON Chief Executive Officer 219-703-2585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207RR0500X Internal Medicine, Rheumatology |
| Enumeration Date | 2023-01-31 |
| Last Update Date | 2023-01-31 |