Organization
PORTER COUNTY ENDOSCOPY CENTER, LLC
Active
Other names
Endolabs
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN PAUL MD (ADMINISTRATOR)
(219) 934-5300
Entity
Organization
Contact information
Practice address
2206 ROOSEVELT RD, SUITE B, VALPARAISO, IN 46383-2749
(219) 548-9990
Mailing address
2206 ROOSEVELT RD, VALPARAISO, IN 46383-2749
(219) 548-9990
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
06004288
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200513280A
—
IN
Enumeration date
10/11/2006
Last updated
11/25/2008
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