Healthcare Provider Details

I. General information

NPI: 1427895705
Provider Name (Legal Business Name): EMPOWER MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 LAPORTE AVE UNIT 131
VALPARAISO IN
46383
US

IV. Provider business mailing address

PO BOX 3231
MUNSTER IN
46321-0231
US

V. Phone/Fax

Practice location:
  • Phone: 219-200-2022
  • Fax:
Mailing address:
  • Phone: 192-200-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANA STEDMAN
Title or Position: CEO
Credential: PA-C
Phone: 515-230-4062