Provider Demographics
NPI:1003814815
Name:ELKHART GENERAL HOSPITAL, INC.
Entity type:Organization
Organization Name:ELKHART GENERAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:2020 INDUSTRIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-5411
Mailing Address - Country:US
Mailing Address - Phone:574-524-7582
Mailing Address - Fax:574-524-7597
Practice Address - Street 1:2020 INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-5411
Practice Address - Country:US
Practice Address - Phone:574-524-7582
Practice Address - Fax:574-524-7597
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELKHART GENERAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-14
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301007051251F00000X
IN60005276A251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200432360AMedicaid
IN000000107217OtherANTHEM BCBS #