Organization
INDIANA UNIVERSITY HEALTH LA PORTE PHYSICIANS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUDSTEINN THOR THORDARSON (PRESIDENT/CEO)
(219) 326-2555
Entity
Organization
Contact information
Practice address
1300 STATE ST, SUITE 1F, LA PORTE, IN 46350-3185
(219) 362-6297
(219) 324-3061
Mailing address
1300 STATE ST, SUITE 1F, LA PORTE, IN 46350-3185
(219) 362-6297
(219) 324-3061
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6993350001
MEDICARE DME
IN
01
—
PENDING
MEDICARE DME
IN
Enumeration date
01/29/2014
Last updated
05/09/2014
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