Provider Demographics
NPI:1225380926
Name:FRANCISCAN HEALTH MICHIGAN CITY
Entity type:Organization
Organization Name:FRANCISCAN HEALTH MICHIGAN CITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-877-1410
Mailing Address - Street 1:757 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2911
Mailing Address - Country:US
Mailing Address - Phone:219-407-6894
Mailing Address - Fax:219-836-2464
Practice Address - Street 1:757 45TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2911
Practice Address - Country:US
Practice Address - Phone:219-836-1899
Practice Address - Fax:219-836-2464
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN HEALTH MICHIGAN CITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-05
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201199900AMedicaid
IN6723650001Medicare NSC