Healthcare Provider Details

I. General information

NPI: 1891898730
Provider Name (Legal Business Name): EDWARD I PORTER M.DIV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 ARMSTRONG ROAD BATTLE CREEK VAMC
BATTLE CREEK MI
49071
US

IV. Provider business mailing address

5500 ARMSTRONG ROAD BATTLE CREEK VAMC CHAPLAIN SECTION (012C)
BATTLE CREEK MI
49071
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-5600
  • Fax: 269-660-5008
Mailing address:
  • Phone: 269-966-5600
  • Fax: 269-660-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: