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General NPI Number Information
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NPI Number | 1467531335
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Entity Type | Organization
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Legal Business Name | INDIANA UNIVERSITY HEALTH LA PORTE HOSPITAL INC
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 311 BOYD BLVD
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City | LA PORTE
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State | IN
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Zip | 46350-3965
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Country | US
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Telephone | 219-326-2664
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Fax | 219-325-5435
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Provider Business Mailing Address
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Address Line | 311 BOYD BLVD
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City | LA PORTE
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State | IN
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Zip | 46350-3965
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Country | US
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Telephone | 219-326-2664
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Fax | 219-325-5435
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | G THOR THORDARSON
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Credential |
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Telephone | 219-326-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 09-005006-1
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License Number State | IN
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