Provider Demographics
NPI:1083714190
Name:NORTHERN INDIANA OCCUPATIONAL MEDICINE SERVICES LLC
Entity Type:Organization
Organization Name:NORTHERN INDIANA OCCUPATIONAL MEDICINE SERVICES LLC
Other - Org Name:NIOMS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEICHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-763-6423
Mailing Address - Street 1:PO BOX 2028
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5528
Mailing Address - Country:US
Mailing Address - Phone:219-762-4050
Mailing Address - Fax:219-762-7814
Practice Address - Street 1:813 LAPORTE AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5801
Practice Address - Country:US
Practice Address - Phone:219-465-4950
Practice Address - Fax:219-548-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty