Northshore Edison Senior High School

LBN: Northshore Health Centers, Inc.
Northshore Edison Senior High School is an health care organization with primary practice located at 3304 Parkside Ave , Lake Station IN 46405-1143. The organization recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC), Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) is the primary health care specialty. Northshore Health Centers, Inc. can be contacted via phone (219) 763-8112, or through Hall, David via phone (219) 763-8112.

Contact Information

Primary practice address
3304 Parkside Ave Lake Station IN 46405-1143
Phone: (219) 763-8112
Fax: (219) 962-1860
Website:
Map and Directions
Authorized official contact:
Name: Hall, David
Phone: (219) 763-8112

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X
Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) 261QF0400X
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X

Profile Details

NPI number 1972895647
LBN Legal business name Northshore Health Centers, Inc.
DBA Doing business as Northshore Edison Senior High School
Authorized official Hall, David
Entity Organization
Organization subpart 1 No
Enumeration date May 12th, 2011
Last updated Sep 22nd, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972895647 NPPES
Indiana Other 191360 MEDICARE PART B PTAN
Indiana Other 151874 MEDICARE PART B PTAN
Indiana MEDICAID 200331170F MEDICARE PART B PTAN

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