NPIMap

Organization Active NPI

Portage Health Center Occupational Health

  • Occupational Medicine Clinic/Center
  • Portage, IN
National Provider Identifier
1104157064
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X
Legal business name
PORTAGE HEALTH CENTER OCCUPATIONAL HEALTH
Practice address
3545 Arbor Blvd
Portage, IN 46368-4297
Phone
(219) 759-4604
Fax
(219) 759-4604
NPI assigned
Jan 15, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kevin Mybeck
Title
Director of Managed Care
Phone
(219) 392-7064

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine Clinic/Center 261QX0100X Primary

Addresses

Primary practice location

3545 Arbor Blvd
Portage, IN 46368-4297

Mailing address

3545 Arbor Blvd
Portage, IN 46368-4297
Phone (219) 759-4604

National Provider Directory

National Provider Directory
Tax ID family
Ancilla Health Services5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1104157064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3545 ARBOR BLVD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463684297",
            "telephone_number": "219-759-4604",
            "fax_number": "219-759-4604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3545 ARBOR BLVD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463684297",
            "telephone_number": "219-759-4604",
            "fax_number": "219-759-4604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTAGE HEALTH CENTER OCCUPATIONAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-15",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "MYBECK",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE",
        "authorized_official_telephone_number": "219-392-7064",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.