1699909069 NPI number — LA PORTE REGIONAL PHYSICIAN NETWORK, INC

Table of content: MS. LAURA ANN KRIPINSKI ARNP (NPI 1770509242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699909069 NPI number — LA PORTE REGIONAL PHYSICIAN NETWORK, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA PORTE REGIONAL PHYSICIAN NETWORK, 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:
1699909069
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1690
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PORTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46352-1690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-326-2312
Provider Business Mailing Address Fax Number:
219-326-2584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 STATE ST
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
LA PORTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46350-3185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-325-3679
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
VOLK
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
219-326-2489

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  01033345 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100165070G , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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