Provider Demographics
NPI:1588190284
Name:GOSHEN HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:GOSHEN HEALTH SYSTEM INC
Other - Org Name:GOSHEN PHYSICIANS DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TARSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-364-2875
Mailing Address - Street 1:2004 ELKHART ROAD
Mailing Address - Street 2:STE A
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526
Mailing Address - Country:US
Mailing Address - Phone:574-364-2611
Mailing Address - Fax:574-364-2784
Practice Address - Street 1:1824 DORCHESTER CT
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526
Practice Address - Country:US
Practice Address - Phone:574-534-2548
Practice Address - Fax:574-534-3622
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOSHEN HEALTH SYSTEM INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-02
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)Group - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)