Provider Demographics
NPI:1164845095
Name:INDIANA UNIVERSITY HEALTH LA PORTE PHYSICIANS INC
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH LA PORTE PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GUDSTEINN
Authorized Official - Middle Name:THOR
Authorized Official - Last Name:THORDARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-326-2555
Mailing Address - Street 1:1300 STATE ST
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3185
Mailing Address - Country:US
Mailing Address - Phone:219-362-6297
Mailing Address - Fax:219-324-3061
Practice Address - Street 1:1300 STATE ST
Practice Address - Street 2:SUITE 1F
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3185
Practice Address - Country:US
Practice Address - Phone:219-362-6297
Practice Address - Fax:219-324-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
INPENDINGOtherMEDICARE DME
IN6993350001OtherMEDICARE DME