# PORTER PHYSICIAN SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Porter Occupational Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376744664
- **Authorized official:** GARY D NEWSOME (PRESIDENT)
- **Authorized official phone:** (615) 465-7000

## Contact information

- **Practice address:** 3220 LANCER ST, PORTAGE, IN 46368-4495
- **Practice address phone:** (219) 764-8439
- **Practice address fax:** (219) 764-8463
- **Mailing address:** PO BOX 2028, PORTAGE, IN 46368-5528
- **Mailing address phone:** (219) 763-6858
- **Mailing address fax:** (219) 763-4858

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | IN | Yes |

## Other

- **Enumeration date:** 05/31/2007
- **Last updated:** 07/21/2022