Provider Demographics
NPI:1497905897
Name:ELKHART GENERAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:ELKHART GENERAL HOSPITAL, INC.
Other - Org Name:QUALITY CARE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:MR
Authorized Official - First Name:C.
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KRAFT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:574-523-7914
Mailing Address - Street 1:6910 N MAIN ST
Mailing Address - Street 2:UNIT #34
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9680
Mailing Address - Country:US
Mailing Address - Phone:574-277-7860
Mailing Address - Fax:574-277-7861
Practice Address - Street 1:6910 N MAIN ST
Practice Address - Street 2:UNIT #34
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9680
Practice Address - Country:US
Practice Address - Phone:574-277-7860
Practice Address - Fax:574-277-7861
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELKHART GENERAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050228A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0000000000Medicare PIN