1720229792 NPI number — INDIANA UNIVERSITY HEALTH LAPORTE HOSPITAL, INC

Table of content: (NPI 1720229792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720229792 NPI number — INDIANA UNIVERSITY HEALTH LAPORTE HOSPITAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA UNIVERSITY HEALTH LAPORTE HOSPITAL, 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:
6
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:
1720229792
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1007 LINCOLNWAY
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:
46350-3201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-326-2591
Provider Business Mailing Address Fax Number:
219-326-2578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1007 LINCOLNWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PORTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46350-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-326-2591
Provider Business Practice Location Address Fax Number:
219-326-2578
Provider Enumeration Date:
03/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LOEFFLER
Authorized Official First Name:
CARRIE
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
219-326-2591

Provider Taxonomy Codes

  • Taxonomy code: 3336I0012X , with the licence number:  60002029A , 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: 1516105 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1516105 . This is a "NCPDP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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