1467406074 NPI number — SAINT JOSEPH REGIONAL MEDICAL CENTER, INC.

Table of content: (NPI 1467406074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467406074 NPI number — SAINT JOSEPH REGIONAL MEDICAL CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT JOSEPH REGIONAL MEDICAL CENTER, 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:
Provider Other Organization Name Type Code:
6
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:
1467406074
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5215 HOLY CROSS PKWY
Provider Second Line Business Mailing Address:
PROVIDER SERVICES-ENROLLMENT
Provider Business Mailing Address City Name:
MISHAWAKA
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46545-1469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60101 BODNAR BLVD STE 100B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISHAWAKA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46544-9340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-335-8500
Provider Business Practice Location Address Fax Number:
574-335-0794
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KARAM
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
574-335-5000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100461640B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ6650 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 021236800 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100461640F , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300086087 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100461640G , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100382620A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100461640E , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100461640H , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200041520D , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300000754 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100461640D , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300046748 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100173780A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200045130A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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