=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205170792
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PORTER COUNTY AUDITORS OFFICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2012
-----------------------------------------------------
Last Update Date | 11/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 155 INDIANA AVE SUITE 104
-----------------------------------------------------
City | VALPARAISO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46383-5502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-465-3525
-----------------------------------------------------
Fax | 219-465-3531
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 155 INDIANA AVE SUITE 204
-----------------------------------------------------
City | VALPARAISO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46383-5502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-465-3350
-----------------------------------------------------
Fax | 219-465-3806
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING REPRESENTATIVE
-----------------------------------------------------
Name | CAMERON MCELLHINEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-697-0695
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------