NPIMap

Northshore Health Centers, Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · La Porte, IN

NPI 1154097426 · NPPES record last updated Aug 18, 2021

Key facts

NPI
1154097426
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
NORTHSHORE HEALTH CENTERS, INC.
Practice address
504 Legacy PLZ W
La Porte, IN 46350-5254
Phone
(219) 763-8112
Fax
(219) 764-5333
NPI assigned
Aug 18, 2021
Organization subpart
Yes
Parent organization (as reported)
NORTHSHORE HEALTH CENTERS, INC.

Authorized official

Name
David Hall
Title
Ceo
Phone
(219) 763-8112

Corporate family (same tax ID) 27

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

View all 27

National Provider Directory

Tax ID family
Northshore Health CTRS Inc (28 organizations share this tax ID)
Part of
Northshore Health CTRS Inc

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes
Pharmacy 333600000X

Addresses

Primary practice location

504 Legacy PLZ W
La Porte, IN 46350-5254

Mailing address

PO Box 1430
Portage, IN 46368-9230
Phone (219) 763-8112

Other names

  • NorthShore LaPorte Pharmacy Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 18, 2021.

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629244800000",
    "number": "1154097426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1430",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463689230",
            "telephone_number": "219-763-8112",
            "fax_number": "219-764-5333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 LEGACY PLZ W",
            "city": "LA PORTE",
            "state": "IN",
            "postal_code": "463505254",
            "telephone_number": "219-763-8112",
            "fax_number": "219-764-5333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSHORE HEALTH CENTERS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHSHORE HEALTH CENTERS, INC.",
        "enumeration_date": "2021-08-18",
        "last_updated": "2021-08-18",
        "certification_date": "2021-07-26",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "219-763-8112"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NorthShore LaPorte Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Porte, IN

All providers in La Porte, IN · Federally Qualified Health Center (FQHC) in Indiana

Sources for this page

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