Provider Demographics
NPI:1205846169
Name:NORTHEN INDIANA HEALTH CENTER
Entity Type:Organization
Organization Name:NORTHEN INDIANA HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENOIT
Authorized Official - Middle Name:O
Authorized Official - Last Name:CHOINIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-232-3000
Mailing Address - Street 1:2610 E JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-2724
Mailing Address - Country:US
Mailing Address - Phone:574-232-3000
Mailing Address - Fax:574-236-4409
Practice Address - Street 1:2610 E JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-2724
Practice Address - Country:US
Practice Address - Phone:574-232-3000
Practice Address - Fax:574-236-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4585150001Medicare NSC