Organization
PORTER PHYSICIAN SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7626
Entity
Organization
Contact information
Practice address
650 DICKINSON RD, CHESTERTON, IN 46304-3387
(219) 477-1013
(219) 548-1410
Mailing address
650 DICKINSON RD, CHESTERTON, IN 46304-3387
(219) 477-1013
(219) 477-1410
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200865650A
—
IN
Enumeration date
05/18/2007
Last updated
06/27/2008
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