| Northshore Laporte Health Center | |
|
508 Legacy Plz W La Porte IN 46350-5254 | |
| (219) 728-1638 | |
| (219) 728-1639 |
| Full Name | Northshore Laporte Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 508 Legacy Plz W, La Porte, Indiana |
| Authorized Official Name and Position | David Hall (CEO) |
| Authorized Official Contact | 2197638112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northshore Laporte Health Center Po Box 1430 Portage IN 46368-9230 Ph: (219) 763-8112 | Northshore Laporte Health Center 508 Legacy Plz W La Porte IN 46350-5254 Ph: (219) 728-1638 |
| NPI Number | 1417519000 |
|---|---|
| Provider Enumeration Date | 07/03/2019 |
| Last Update Date | 06/19/2023 |
| Certification Date | 06/19/2023 |
| Medicare PECOS PAC ID | 5799671236 |
|---|---|
| Medicare Enrollment ID | O20190724000128 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417519000 | NPI | - | NPPES |
| 151054 | Other | IN | MEDICARE PTAN |
| 300031202 | Medicaid | IN | |
| 191360 | Other | IN | MEDICARE |
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