1184703704 NPI number — INDIANA UNIVERSITY HEALTH LA PORTE HOSPITAL INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184703704 NPI number — INDIANA UNIVERSITY HEALTH LA PORTE HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA UNIVERSITY HEALTH LA PORTE HOSPITAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LA PORTE REGIONAL HEALTH SYSTEM INC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184703704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
08/07/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1007 LINCOLNWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PORTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46352-0250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-326-1234
Provider Business Mailing Address Fax Number:
219-325-5403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1007 LINCOLNWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PORTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46352-0250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-326-1234
Provider Business Practice Location Address Fax Number:
219-325-5403
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THORDARSON
Authorized Official First Name:
G
Authorized Official Middle Name:
THOR
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
219-326-2555

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , with the licence number:  09-005006-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273Y00000X , with the licence number: 11-005006-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100269110 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000097783 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200714310 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700339 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100269120 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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