Great Lakes Surgical Suites, LLC
Organization Active NPI Ambulatory Surgical Clinic/Center · Munster, IN
NPI 1093245458 · NPPES record last updated Oct 7, 2024
Key facts
- NPI
- 1093245458
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulatory Surgical Clinic/Center 261QA1903X
- Legal business name
- GREAT LAKES SURGICAL SUITES, LLC
- Practice address
- 9200 Calumet Ave Ste N500
Munster, IN 46321-2849 - Phone
- (219) 513-9955
- Fax
- (219) 513-9373
- NPI assigned
- Jun 18, 2017
- Organization subpart
- No
Authorized official
- Name
- Christopher Hartshorn
- Title
- Officer/Authorized Official
- Phone
- (314) 800-2017
Member of 2
Medicare Care Compare: Ambulatory surgical center
- Listed as
- Great Lakes Surgical Suites LLC Dba Great Lakes Surgical Suites
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2136751 | Great Lakes Surgical Suites, LLC | Certificate of waiver | Sep 13, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170825001951 | IN | Part B Supplier - Ambulatory Surgical Center | 3779855754 | Practice locations: Munster, IN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | Yes |
Addresses
Primary practice location
9200 Calumet Ave Ste N500
Munster, IN 46321-2849
Mailing address
14201 Dallas Pkwy
Dallas, TX 75254-2916
Phone (219) 513-9955
Other names
- Great Lakes Surgical Suites
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Other providers in Munster, IN
- Neil Gorski
- Emil H Govani
- Christina Graham
- Cassondra Grahovac
- Sandra J Grano-Vrbanoff
- Alecia Green
- Mitchell Wayne Green
- Sierra N Green
- Catherine Elizabeth Gregori
- Tyler Gress
All providers in Munster, IN · Ambulatory Surgical Clinic/Center in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 7, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.