Healthcare Provider Details

I. General information

NPI: 1801943725
Provider Name (Legal Business Name): PORTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 LAPORTE AVE
VALPARAISO IN
46383-5860
US

IV. Provider business mailing address

814 LAPORTE AVE
VALPARAISO IN
46383-5860
US

V. Phone/Fax

Practice location:
  • Phone: 219-263-4767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateIN

VIII. Authorized Official

Name: PATRICIA A GIBSON
Title or Position: MANAGER, PFS
Credential:
Phone: 219-263-4767