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NPI Code Detail

MEDICARE: PORTER PHYSICIAN SERVICES LLC

MEDICARE: PORTER PHYSICIAN SERVICES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician
2207X00000XOrthopaedic Surgery Physician
3208800000XUrology Physician
4363L00000XNurse Practitioner28143009AIN
5207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2DG1244OTHERINRR MCR
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
45251392OTHERINAETNA

General Provider Information

NPI Number : 1508075680
Entity Type Code : Organization
Provider Name (Legal Business Name) : PORTER PHYSICIAN SERVICES LLC
Provider Business Mailing Address
First Line : PO BOX 689022
Second Line :
City : FRANKLIN
State : TN
Zip : 37068-9022
Country : US
Telephone Number : 615-465-7402
Fax Number : 615-465-6286
Provider Business Practice Location Address
First Line : 85 E US HIGHWAY 6
Second Line :
City : VALPARAISO
State : IN
Zip : 46383-8947
Country : US
Telephone Number : 219-983-6380
Fax Number : 219-983-6080
Authorized Official
Title or Position : DIRECTOR, PROVIDER ENROLLMENT
Name : KRISTINA MUSIC
Credential :
Telephone Number : 877-892-9815
Provider Enumeration Date : 05/22/2007
Last Update Date : 06/26/2025

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Directions to “PORTER PHYSICIAN SERVICES LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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