1992884878 NPI number — INDIANA UNIVERSITY HEALTH LA PORTE HOSPITAL INC

Table of content: (NPI 1992884878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992884878 NPI number — INDIANA UNIVERSITY HEALTH LA PORTE HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA UNIVERSITY HEALTH LA PORTE 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:
COMMUNITY HEALTH CENTER OF LAPORTE
Provider Other Organization Name Type Code:
3
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:
1992884878
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
08/07/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 TEEGARDEN
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:
46350-3175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-326-2403
Provider Business Mailing Address Fax Number:
219-326-2385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 TEEGARDEN
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:
46350-3175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-326-2403
Provider Business Practice Location Address Fax Number:
219-326-2385
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THORDARSON
Authorized Official First Name:
G
Authorized Official Middle Name:
THOR
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
219-326-2555

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  06-005006-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD0000X , with the licence number: 11-005006-1 , 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: 200237780A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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