Provider Demographics
NPI:1154440675
Name:EARLHAM COLLEGE
Entity Type:Organization
Organization Name:EARLHAM COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:DEITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-983-1328
Mailing Address - Street 1:801 NATIONAL RD W
Mailing Address - Street 2:HEALTH SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4021
Mailing Address - Country:US
Mailing Address - Phone:765-983-1328
Mailing Address - Fax:765-983-1488
Practice Address - Street 1:801 NATIONAL RD W
Practice Address - Street 2:HEALTH SERVICES
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4021
Practice Address - Country:US
Practice Address - Phone:765-983-1328
Practice Address - Fax:765-983-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025101261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health