# PORTAGE HEALTH CENTER OCCUPATIONAL HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104157064
- **Authorized official:** MR. KEVIN MYBECK (DIRECTOR OF MANAGED CARE)
- **Authorized official phone:** (219) 392-7064

## Contact information

- **Practice address:** 3545 ARBOR BLVD, PORTAGE, IN 46368-4297
- **Practice address phone:** (219) 759-4604
- **Practice address fax:** (219) 759-4604
- **Mailing address:** 3545 ARBOR BLVD, PORTAGE, IN 46368-4297
- **Mailing address phone:** (219) 759-4604
- **Mailing address fax:** (219) 759-4604

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QX0100X | Occupational Medicine Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/15/2010
- **Last updated:** 07/11/2024