Provider Demographics
NPI:1386917912
Name:FRANCISCAN HAMMOND CLINIC LLC
Entity type:Organization
Organization Name:FRANCISCAN HAMMOND CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-836-5800
Mailing Address - Street 1:7905 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2549
Mailing Address - Country:US
Mailing Address - Phone:219-836-5800
Mailing Address - Fax:219-836-8073
Practice Address - Street 1:11355 W 97TH LN
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9601
Practice Address - Country:US
Practice Address - Phone:219-836-5800
Practice Address - Fax:219-836-8073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01021975207N00000X
IN02002075207Q00000X
IN01027708207V00000X
IN01028626208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201024850Medicaid
INM100047715Medicare PIN