Healthcare Provider Details

I. General information

NPI: 1164483590
Provider Name (Legal Business Name): PORTER HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 DICKINSON RD SUITE A
CHESTERTON IN
46304-3387
US

IV. Provider business mailing address

541 OTIS BOWEN DR
MUNSTER IN
46321-4158
US

V. Phone/Fax

Practice location:
  • Phone: 219-926-2133
  • Fax: 219-926-8875
Mailing address:
  • Phone: 219-934-5300
  • Fax: 219-934-5389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CAROL HAMMOND
Title or Position: CFO
Credential:
Phone: 219-364-3660