NORTHSHORE HEALTH CENTERS INC. NPI 1972895647

NPI Information

NPI: 1972895647
Provider Name: NORTHSHORE HEALTH CENTERS, INC.

Doing Business As: NORTHSHORE EDISON SENIOR HIGH SCHOOL

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
3304 PARKSIDE AVE
LAKE STATION, IN
ZIP 46405
Phone: (219) 763-8112
Get Directions

NORTHSHORE HEALTH CENTERS, INC. is a federally qualified health center (fqhc) clinic center in Lake Station, IN. NORTHSHORE HEALTH CENTERS, INC. NPI is 1972895647. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Northshore Edison Senior High School.

The provider's business location address is:

3304 PARKSIDE AVE
LAKE STATION, IN
ZIP 46405-143
Phone: (219) 763-8112
Fax: (219) 962-1860

The provider's authorized official is David Hall .
The authorized official title is Ceo and has the following contact phone number (219) 763-8112.

The CLIA number assigned to this NPI record is 15D1036004 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/12/2011 and was last updated on 9/22/2020.

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	Primary
1	207Q00000X	Family Medicine		No
2	363L00000X	Nurse Practitioner		No
3	363LF0000X	Nurse Practitioner	Family	No
4	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	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	191360	OTHER	INDIANA	MEDICARE PART B PTAN
2	151874	OTHER	INDIANA	MEDICARE PART A PTAN
3	200331170F	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

NPI Synchronization or Removal

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