Organization
MEMORIAL HEALTH SYSTEM, INC.
Active
Other names
LaPorte PT
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY COSTELLO (VP-CFO)
(574) 647-3549
Entity
Organization
Contact information
Practice address
900 I ST, LA PORTE, IN 46350-5533
(219) 324-1700
Mailing address
328 N MICHIGAN ST, SUITE 200, SOUTH BEND, IN 46601-1244
(574) 647-1069
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000178974
ANTHEM
IN
Enumeration date
04/17/2007
Last updated
08/22/2020
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