Provider Demographics
NPI:1194473595
Name:PORTER-STARKE SERVICES INC.
Entity Type:Organization
Organization Name:PORTER-STARKE SERVICES INC.
Other - Org Name:MARRAM HEALTH CENTER SUITE 104
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP SYSTEMS ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-476-4664
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:219-806-3000
Mailing Address - Fax:
Practice Address - Street 1:3229 BROADWAY STE 104
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46409-1041
Practice Address - Country:US
Practice Address - Phone:219-806-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)