=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962455360
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LA PORTE REGIONAL PHYSICIAN NETWORK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 06/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 DUNES PLZ HWY 421 & 20
-----------------------------------------------------
City | MICHIGAN CITY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46360-7340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-787-8266
-----------------------------------------------------
Fax | 219-878-2670
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1690
-----------------------------------------------------
City | LA PORTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46352-1690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-326-2489
-----------------------------------------------------
Fax | 219-326-2584
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | RHONDA VOLK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 219-326-2485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------