Healthcare Provider Details

I. General information

NPI: 1386880060
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH LA PORTE HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TEEGARDEN ST
LA PORTE IN
46350-3175
US

IV. Provider business mailing address

1007 LINCOLNWAY PO BOX 250
LA PORTE IN
46350-3201
US

V. Phone/Fax

Practice location:
  • Phone: 219-326-0043
  • Fax:
Mailing address:
  • Phone: 219-326-2403
  • Fax: 219-326-2385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. G THOR THORDARSON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 219-326-2555