PORTER PHYSICIAN SERVICES LLC NPI 1508075680

NPI Information

NPI: 1508075680
Provider Name: PORTER PHYSICIAN SERVICES LLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 15D0355872

Address:
650 DICKINSON RD
SUITE A
CHESTERTON, IN
ZIP 46304
Phone: (219) 926-2133
Get Directions

PORTER PHYSICIAN SERVICES LLC is a family medicine in Chesterton, IN. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. PORTER PHYSICIAN SERVICES LLC NPI is 1508075680. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

650 DICKINSON RD
SUITE A
CHESTERTON, IN
ZIP 46304-387
Phone: (219) 926-2133
Fax: (219) 926-8765

The provider's authorized official is Jennifer L Jackson .
The authorized official title is Sr Director, Provider Enrollment and has the following contact phone number (615) 465-3334.

The CLIA number assigned to this NPI record is 15D0355872 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/22/2007 and was last updated on 6/8/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	208800000X	Urology			No
2	207R00000X	Internal Medicine			No
3	207X00000X	Orthopaedic Surgery			No
4	363L00000X	Nurse Practitioner	28143009A	INDIANA	No
5	207Q00000X	Family Medicine			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100388930	MEDICAID	INDIANA
2	5251392	OTHER	INDIANA	AETNA
3	113435	OTHER	INDIANA	ANTHEM MEDICAID
4	DG1244	OTHER	INDIANA	RR MCR

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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