LA PORTE REGIONAL PHYSICIAN NETWORK (DALPHOND CLINIC) - NPI NUMBER 1942466354

Summary

Provider Name: LA PORTE REGIONAL PHYSICIAN NETWORK (DALPHOND CLINIC)

NPI Number: 1942466354

Clasification: Family Medicine (207Q00000X)

Address:
108 W STATE ST
NORTH JUDSON, IN
ZIP 46366

Phone Number: (574) 896-5533



Detailed Information

LA PORTE REGIONAL PHYSICIAN NETWORK is a family physician in North Judson, IN. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. The assigned NPI number for this provider is 1942466354 and is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Dalphond Clinic.

The provider's business address is:

108 W STATE ST
NORTH JUDSON, IN
ZIP 46366-320
Phone: (574) 896-5533
Fax: (574) 896-5218

The provider's authorized official is Rhonda Volk .
The authorized official title is Executive Director and has the following contact phone number (219) 326-2485.

The enumeration date for this NPI number is 8/5/2008 and was last updated on 4/22/2009.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207Q00000X Family Medicine Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 760420 OTHER IN MEDICARE
2 151020 MEDICARE PIN IN
3 100165070E MEDICAID IN

NPI Record

No. Field Name Field Value
1 NPI 1942466354
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name LA PORTE REGIONAL PHYSICIAN NETWORK
5 Provider Other Organization Name DALPHOND CLINIC
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 108 W STATE ST
8 Provider Business Practice Location Address City Name NORTH JUDSON
9 Provider Business Practice Location Address State Name IN
10 Provider Business Practice Location Address Postal Code 463661320
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 5748965533
13 Provider Business Practice Location Address Fax Number 5748965218
14 Provider Enumeration Date 8/5/2008
15 Last Update Date 4/22/2009
16 Authorized Official Last Name VOLK
17 Authorized Official First Name RHONDA
18 Authorized Official Title or Position EXECUTIVE DIRECTOR
19 Authorized Official Telephone Number 2193262485
20 Healthcare Provider Taxonomy Code 1 207Q00000X
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 760420
23 Other Provider Identifier Type Code 1 01
24 Other Provider Identifier State 1 IN
25 Other Provider Identifier Issuer 1 MEDICARE
26 Other Provider Identifier 2 151020
27 Other Provider Identifier Type Code 2 08
28 Other Provider Identifier State 2 IN
29 Other Provider Identifier 3 100165070E
30 Other Provider Identifier Type Code 3 05
31 Other Provider Identifier State 3 IN
32 Is Organization Subpart N
33 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 7/15/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.