Provider Demographics
NPI:1942402573
Name:LA PORTE REGIONAL PHYSICIAN NETWORK
Entity Type:Organization
Organization Name:LA PORTE REGIONAL PHYSICIAN NETWORK
Other - Org Name:NORTHERN IN CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
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:219-326-2485
Mailing Address - Street 1:PO BOX 1690
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46352-1690
Mailing Address - Country:US
Mailing Address - Phone:219-326-2312
Mailing Address - Fax:219-326-2584
Practice Address - Street 1:901 LINCOLNWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3430
Practice Address - Country:US
Practice Address - Phone:219-362-7506
Practice Address - Fax:219-362-1459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA PORTE REGIONAL PHYSICIAN NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-05
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038951207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100165070YMedicaid
IN151020Medicare PIN