Basic Information
| Provider Information | |||||||||
| NPI: | 1225348733 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAPORTE REGIONAL PHYSICIAN NETWORK, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 LINCOLNWAY | ||||||||
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| City: | LA PORTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193262489 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 W KIEFFER RD | ||||||||
| Address2: | |||||||||
| City: | MICHIGAN CITY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463609599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198796262 | ||||||||
| FaxNumber: | 2198741885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2010 | ||||||||
| LastUpdateDate: | 10/20/2010 | ||||||||
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| AuthorizedOfficialLastName: | VOLK | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2193262489 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 71003388 | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.