Healthcare Provider Details

I. General information

NPI: 1558322982
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: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 WILLOWCREEK RD
PORTAGE IN
46368-5075
US

IV. Provider business mailing address

26700 BROOKPARK ROAD EXT SUITE 1
NORTH OLMSTED OH
44070-3124
US

V. Phone/Fax

Practice location:
  • Phone: 219-759-5791
  • Fax: 219-759-3807
Mailing address:
  • Phone: 800-611-6912
  • Fax: 440-716-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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