Provider Demographics
NPI:1508863846
Name:NORTHERN INDIANA HEALTH CENTER
Entity Type:Organization
Organization Name:NORTHERN INDIANA HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENOIT
Authorized Official - Middle Name:O
Authorized Official - Last Name:CHOINIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-522-7203
Mailing Address - Street 1:640 INDUSTRIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-5414
Mailing Address - Country:US
Mailing Address - Phone:574-522-7203
Mailing Address - Fax:
Practice Address - Street 1:640 INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-5414
Practice Address - Country:US
Practice Address - Phone:574-522-7203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN111N00000X, 207Q00000X, 225100000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN216120Medicare ID - Type Unspecified
IN216110Medicare ID - Type Unspecified
IN221840Medicare ID - Type Unspecified