NPIMap

Organization Active NPI

Indiana University Health la Porte Hospital Inc

  • Occupational Medicine Clinic/Center
  • La Porte, IN
National Provider Identifier
1467531335
Registry record updated Sep 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X
License
09-005006-1 Issued in IN
Legal business name
INDIANA UNIVERSITY HEALTH LA PORTE HOSPITAL INC
Practice address
311 Boyd Blvd
La Porte, IN 46350-3965
Phone
(219) 326-2664
Fax
(219) 325-5435
NPI assigned
Nov 3, 2006
Reactivated
Aug 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2013

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

Authorized official

Name
G Thor Thordarson
Title
President/Ceo
Phone
(219) 326-2555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine Clinic/Center 261QX0100X 09-005006-1 IN Primary

Addresses

Primary practice location

311 Boyd Blvd
La Porte, IN 46350-3965

Mailing address

311 Boyd Blvd
La Porte, IN 46350-3965
Phone (219) 326-2664

Other identifiers 4

IdentifierTypeStateIssuer
110269120MedicaidIN
000000097783OtherINANTHEM
700339MedicaidIN
100269110MedicaidIN

Other names 1

  • LaPorte Occupational Health Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Laporte Regional Health System Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

311 Boyd Blvd
Laporte, IN 46350
Phone (219) 326-2654

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379289600000",
    "number": "1467531335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 BOYD BLVD",
            "city": "LA PORTE",
            "state": "IN",
            "postal_code": "463503965",
            "telephone_number": "219-326-2664",
            "fax_number": "219-325-5435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 BOYD BLVD",
            "city": "LA PORTE",
            "state": "IN",
            "postal_code": "463503965",
            "telephone_number": "219-326-2664",
            "fax_number": "219-325-5435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA UNIVERSITY HEALTH LA PORTE HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2013-09-16",
        "deactivation_date": "2007-07-17",
        "reactivation_date": "2007-08-07",
        "status": "A",
        "authorized_official_last_name": "THORDARSON",
        "authorized_official_first_name": "G",
        "authorized_official_middle_name": "THOR",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "219-326-2555"
    },
    "taxonomies": [
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": "IN",
            "license": "09-005006-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110269120",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000097783",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "700339",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100269110",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LaPorte Occupational Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in La Porte, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2013; 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.