Provider Demographics
NPI:1003371220
Name:PORTER-STARKE SERVICES INC
Entity Type:Organization
Organization Name:PORTER-STARKE SERVICES INC
Other - Org Name:MARRAM HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP SYSTEMS ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:AILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-476-4567
Mailing Address - Street 1:601 WALL ST
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2512
Mailing Address - Country:US
Mailing Address - Phone:219-806-3011
Mailing Address - Fax:
Practice Address - Street 1:MARRAM HEALTH CENTER
Practice Address - Street 2:3229 BROADWAY SUITE 160
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46409-1040
Practice Address - Country:US
Practice Address - Phone:219-806-3011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)