1588190284 NPI number — GOSHEN HEALTH SYSTEM INC

Table of content: (NPI 1588190284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588190284 NPI number — GOSHEN HEALTH SYSTEM INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOSHEN HEALTH SYSTEM 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:
GOSHEN PHYSICIANS DIAGNOSTICS
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:
1588190284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2004 ELKHART ROAD
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
GOSHEN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-364-2611
Provider Business Mailing Address Fax Number:
574-364-2784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1824 DORCHESTER CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOSHEN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-534-2548
Provider Business Practice Location Address Fax Number:
574-534-3622
Provider Enumeration Date:
05/02/2017

Additional Information

Authorized Official

Authorized Official Last Name:
TARSKE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
574-364-2875

Provider Taxonomy Codes

  • Taxonomy code: 207RM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2471M1202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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