Provider Demographics
NPI:1437191152
Name:SAINT JOSEPH COMMUNITY HOSPITAL OF MISHAWAKA, INC.
Entity Type:Organization
Organization Name:SAINT JOSEPH COMMUNITY HOSPITAL OF MISHAWAKA, INC.
Other - Org Name:MIDWIFERY OF MICHIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-258-1293
Mailing Address - Street 1:420 W 4TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-1948
Mailing Address - Country:US
Mailing Address - Phone:574-252-0300
Mailing Address - Fax:574-252-0303
Practice Address - Street 1:420 W 4TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-1948
Practice Address - Country:US
Practice Address - Phone:574-252-0300
Practice Address - Fax:574-252-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100092440AMedicaid