Provider Demographics
NPI:1144368853
Name:THE METHODIST HOSPITAL MEDICAL NUTRITION CENTER
Entity type:Organization
Organization Name:THE METHODIST HOSPITAL MEDICAL NUTRITION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEDICAL NUTRITION SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:D
Authorized Official - Last Name:ARGENTA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:219-886-4650
Mailing Address - Street 1:600 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46402-6001
Mailing Address - Country:US
Mailing Address - Phone:219-886-4650
Mailing Address - Fax:219-886-4580
Practice Address - Street 1:600 GRANT ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-6001
Practice Address - Country:US
Practice Address - Phone:219-886-4650
Practice Address - Fax:219-886-4580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN189450133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN189450Medicare ID - Type UnspecifiedMEDICAL NUTRITION THERAPY