Provider Demographics
NPI:1225348733
Name:LAPORTE REGIONAL PHYSICIAN NETWORK, INC.
Entity Type:Organization
Organization Name:LAPORTE REGIONAL PHYSICIAN NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-326-2489
Mailing Address - Street 1:1100 LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46352
Mailing Address - Country:US
Mailing Address - Phone:219-326-2489
Mailing Address - Fax:
Practice Address - Street 1:601 W KIEFFER RD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9599
Practice Address - Country:US
Practice Address - Phone:219-879-6262
Practice Address - Fax:219-874-1885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty