Organization
PORTER PHYSICIAN SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINA MUSIC (DIRECTOR, PROVIDER ENROLLMENT)
(877) 892-9815
Entity
Organization
Contact information
Practice address
85 E US HIGHWAY 6, VALPARAISO, IN 46383-8947
(219) 983-6380
(219) 983-6080
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7402
(615) 465-6286
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208800000X
Urology Physician
—
—
363L00000X
Nurse Practitioner
28143009A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100388930
—
IN
01
—
113435
ANTHEM MEDICAID
IN
01
—
5251392
AETNA
IN
01
—
DG1244
RR MCR
IN
Enumeration date
05/22/2007
Last updated
06/26/2025
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