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General NPI Number Information
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NPI Number | 1902994924
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Entity Type | Organization
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Legal Business Name | PORTER COUNTY ENDOSCOPY CENTER, LLC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 11/25/2008
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Provider Practice Location Address
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Address Line | 2206 ROOSEVELT RD SUITE B
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City | VALPARAISO
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State | IN
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Zip | 46383-2749
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Country | US
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Telephone | 219-548-9990
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Fax |
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Provider Business Mailing Address
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Address Line | 2206 ROOSEVELT RD
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City | VALPARAISO
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State | IN
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Zip | 46383-2749
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Country | US
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Telephone | 219-548-9990
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | STEPHEN PAUL
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Credential | MD
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Telephone | 219-934-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 06004288
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License Number State | IN
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