Provider Demographics
NPI:1588750749
Name:SURGICAL ASSOCIATES OF NORTHWEST INDIANA, P.C.
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES OF NORTHWEST INDIANA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:STANISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-756-4900
Mailing Address - Street 1:101 E 87TH AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7335
Mailing Address - Country:US
Mailing Address - Phone:219-756-4900
Mailing Address - Fax:219-660-4108
Practice Address - Street 1:101 E 87TH AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7335
Practice Address - Country:US
Practice Address - Phone:219-756-4900
Practice Address - Fax:219-660-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200126440Medicaid
IN200126440Medicaid