Provider Demographics
NPI:1831844539
Name:HEALTHCARE PORT
Entity type:Organization
Organization Name:HEALTHCARE PORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB COORDINATOR/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARYSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-248-4912
Mailing Address - Street 1:804 MARYLAND ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46402-2545
Mailing Address - Country:US
Mailing Address - Phone:219-248-4912
Mailing Address - Fax:
Practice Address - Street 1:720 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-1808
Practice Address - Country:US
Practice Address - Phone:219-248-4912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care HomeGroup - Multi-Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center