360 Integrated Medical Center, PC
Organization Active NPI General Practice Physician · La Porte, IN
NPI 1710459458 · NPPES record last updated Dec 19, 2018
Key facts
- NPI
- 1710459458
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- Legal business name
- 360 INTEGRATED MEDICAL CENTER, PC
- Practice address
- 2504 Monroe St
La Porte, IN 46350-5241 - Phone
- (219) 326-5100
- Fax
- (219) 326-0180
- NPI assigned
- Dec 19, 2018
- Organization subpart
- No
Authorized official
- Name
- Matthew Kirkham
- Title
- Owner
- Phone
- (219) 326-5100
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | Yes |
Addresses
Primary practice location
2504 Monroe St
La Porte, IN 46350-5241
Mailing address
2504 Monroe St
La Porte, IN 46350-5241
Other providers in La Porte, IN
- 1 On 1 Home Health Care, LLC
- Accelerated Rehabilitation Centers, LTD
- Mackenzie Jacquelyn Accorsi
- Advance Pain & Anesthesia Consultants, PC
- Advance Pain & Anesthesia Consultants, PC
- Elissa Aimee Affeld
All providers in La Porte, IN · General Practice Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.