Organization
HEALTHCARE PORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARYSIA ROBERTS (LAB COORDINATOR/DIRECTOR)
(219) 248-4912
Entity
Organization
Contact information
Practice address
720 W 5TH AVE, GARY, IN 46402-1808
(219) 248-4912
Mailing address
804 MARYLAND ST, GARY, IN 46402-2545
(219) 248-4912
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
—
—
246RP1900X
Phlebotomy Technician
Primary
—
—
261Q00000X
Clinic/Center
—
—
311ZA0620X
Adult Care Home Facility
—
—
Other
Enumeration date
02/21/2022
Last updated
02/21/2022
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