Provider Demographics
NPI:1780827642
Name:NORTHWEST INDIANA OCCUPATIONAL MEDICE SERVICES, LLC
Entity type:Organization
Organization Name:NORTHWEST INDIANA OCCUPATIONAL MEDICE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:VANVLIET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-934-5300
Mailing Address - Street 1:541 OTIS BOWEN DR
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4158
Mailing Address - Country:US
Mailing Address - Phone:219-934-5300
Mailing Address - Fax:
Practice Address - Street 1:809 LAPORTE AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5801
Practice Address - Country:US
Practice Address - Phone:219-934-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty