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15D2001341 CLIA NUMBER - LAKE - PORTER MEDICAL GROUP PORTER PHYSICIAN SERVICES LLC

Laboratory Demographics

CLIA Number: 15D2001341

Facility Name: LAKE - PORTER MEDICAL GROUP PORTER PHYSICIAN SERVICES LLC

Facility Address:
336 US HIGHWAY 30 STE A&B
VALPARAISO, IN
ZIP 46383
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Facility Phone Number: 219 464-7430

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1972694669

Taxonomy: 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery)
A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.

CLIA Record

Field Name Field Value
CLIA Number 15D2001341
LAB Type Physician Office
Facility Name LAKE - PORTER MEDICAL GROUP PORTER PHYSICIAN SERVICES LLC
Street 336 US HIGHWAY 30 STE A&B
City VALPARAISO
State IN
ZIP 46383
Phone 219 464-7430
CertificateType 4
CertificateEffectiveDate 12/17/2023
CertificateExpirationDate 12/16/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024