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
3630 WILLOWCREEK RD, PORTAGE, IN 46368-5075
(219) 759-5791
(219) 759-3807
Mailing address
3630 WILLOWCREEK RD, PORTAGE, IN 46368-5075
(219) 759-5791
(219) 759-3807
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200866880A
—
IN
Enumeration date
05/14/2007
Last updated
01/28/2009
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