1689627598 NPI number — PORTER-STARKE SERVICES INC.

Table of content: (NPI 1689627598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689627598 NPI number — PORTER-STARKE SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PORTER-STARKE SERVICES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689627598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 WALL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALPARAISO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46383-2512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-531-3500
Provider Business Mailing Address Fax Number:
219-462-3975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2507 CUMBERLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALPARAISO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46383-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-476-4676
Provider Business Practice Location Address Fax Number:
219-462-3975
Provider Enumeration Date:
05/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
IDSTEIN
Authorized Official First Name:
MARY
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT, FINANCE
Authorized Official Telephone Number:
219-531-3500

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  418-0-CMHC , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X , with the licence number: 418-0-ASR , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 418-14-9-14 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 418-0-GAM , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 418-0-SMI , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X , with the licence number: 61100664B , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100207670A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CB7125 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000112682 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".