Provider Demographics
NPI:1861114365
Name:GOSHEN HEALTH SYSTEM INC
Entity type:Organization
Organization Name:GOSHEN HEALTH SYSTEM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-364-2695
Mailing Address - Street 1:109 W US HWY 20
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-9202
Mailing Address - Country:US
Mailing Address - Phone:574-825-4585
Mailing Address - Fax:574-825-4586
Practice Address - Street 1:109 W US HWY 20
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9202
Practice Address - Country:US
Practice Address - Phone:574-825-4585
Practice Address - Fax:574-825-4586
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOSHEN PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-13
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty