Provider Demographics
NPI:1891922332
Name:ELKHART GENERAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:ELKHART GENERAL HOSPITAL, INC.
Other - Org Name:WOMEN'S CENTER - CONTINENCE CLINIC
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:PO BOX 1887
Mailing Address - Street 2:ELKHART GENERAL PHYSICIAN SERVICES
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46515-1887
Mailing Address - Country:US
Mailing Address - Phone:574-389-0542
Mailing Address - Fax:574-522-8505
Practice Address - Street 1:600 EAST BLVD
Practice Address - Street 2:WOMEN'S CENTER - CONTINENCE CLINIC
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2483
Practice Address - Country:US
Practice Address - Phone:574-523-2751
Practice Address - Fax:574-389-4840
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELKHART GENERAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-11
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09-005017-1207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100114000EMedicaid
INCD5238Medicare PIN
IN262000Medicare PIN