Organization
INDIANA UNIVERSITY HEALTH LA PORTE HOSPITAL INC
Active
Other names
Indiana University Health La Porte VNA Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. G THOR THORDARSON (PRESIDENT/CEO)
(219) 326-2555
Entity
Organization
Contact information
Practice address
901 SOUTH WOODLAND AVENUE, MICHIGAN CITY, IN 46360-5672
(219) 871-8100
(219) 871-8113
Mailing address
901 SOUTH WOODLAND AVENUE, MICHIGAN CITY, IN 46360-5672
(219) 871-8100
(219) 871-8113
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
06-006017-1
IN
251E00000X
Home Health Agency
Primary
11-005255-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000097786
ANTHEM
IN
05
—
200318440
—
IN
01
—
26-7760
MEDICARE PTAN - FLU SHOTS (MASTER ROSTER BILLING)
IN
Enumeration date
11/06/2006
Last updated
06/03/2015
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