| NPI | 1609874254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE GLASS Billing Manager 219-937-5067 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: IN 05-005727-1) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2024-10-09 |