1427056233 NPI number — ELKHART GENERAL HOSPITAL, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427056233 NPI number — ELKHART GENERAL HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELKHART GENERAL HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELKHART GENERAL HOME INFUSION THERAPY (AKA HIT)
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427056233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 EAST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKHART
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46514-2483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-294-6181
Provider Business Mailing Address Fax Number:
574-293-8930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 INDUSTRIAL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKHART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46516-5411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-294-6181
Provider Business Practice Location Address Fax Number:
574-293-8930
Provider Enumeration Date:
07/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KRAFT
Authorized Official First Name:
C.
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
DIRECTOR OF MANAGED CARE
Authorized Official Telephone Number:
574-523-7914

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  05-005017-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000107217 . This is a "ANTHEM BCBS #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200236550A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200432360A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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