SOUTHEASTERN MEDICAL CENTER S.C. NPI 1568589802

NPI Information

NPI: 1568589802
Provider Name: SOUTHEASTERN MEDICAL CENTER S.C.
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 15D0880485

Address:
4020 S CALUMET AVE
HAMMOND, IN
ZIP 46320
Phone: (219) 933-4889
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SOUTHEASTERN MEDICAL CENTER S.C. is a specialist in Hammond, IN. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. SOUTHEASTERN MEDICAL CENTER S.C. NPI is 1568589802. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4020 S CALUMET AVE
HAMMOND, IN
ZIP 46320-129
Phone: (219) 933-4889
Fax: (219) 933-3153

The provider's authorized official is Rajeev Bharel .
The authorized official title is Network Administrator and has the following contact phone number (219) 933-4889.

The CLIA number assigned to this NPI record is 15D0880485 - industrial with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/23/2007 and was last updated on 10/13/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		01031453A	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0509200001	MEDICARE NSC	INDIANA
2	409340	MEDICARE PIN	INDIANA
3	0090001298	OTHER	ILLINOIS	BCBS IL
4	000000105624	OTHER	INDIANA	BLUE CROSS OF IN
5	=========4632702	MEDICAID	ILLINOIS
6	100214150A	MEDICAID	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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