Healthcare Provider Details
I. General information
NPI: 1144691478
Provider Name (Legal Business Name): NORTH INDIANA EMERGENCY PHYSICIANS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/13/2015
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1007 LINCOLNWAY
LA PORTE IN
46350-3201
US
IV. Provider business mailing address
200 CORPORATE BLVD
LAFAYETTE LA
70508-3870
US
V. Phone/Fax
- Phone: 219-326-1234
- Fax:
- Phone: 800-893-9698
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207P00000X |
| Taxonomy | Emergency Medicine Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363A00000X |
| Taxonomy | Physician Assistant |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363L00000X |
| Taxonomy | Nurse Practitioner |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
CHRISTOPHER
LIPSMEYER
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 337-609-1221