Provider Demographics
NPI:1881817963
Name:OFF HOUR MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:OFF HOUR MEDICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIKIRI
Authorized Official - Middle Name:
Authorized Official - Last Name:RATNAYAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-464-8115
Mailing Address - Street 1:PO BOX 1249
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384-1249
Mailing Address - Country:US
Mailing Address - Phone:219-464-8115
Mailing Address - Fax:219-464-8115
Practice Address - Street 1:1910 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2704
Practice Address - Country:US
Practice Address - Phone:241-946-4811
Practice Address - Fax:219-464-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028333207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000085652OtherANTHEM BLUE CROSS PIN
IN000000085652OtherANTHEM BLUE CROSS PIN