Provider Demographics
NPI:1477394286
Name:GOSHEN HEALTH SYSTEM, INC
Entity type:Organization
Organization Name:GOSHEN HEALTH SYSTEM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-364-2560
Mailing Address - Street 1:56853 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-9536
Mailing Address - Country:US
Mailing Address - Phone:574-825-2211
Mailing Address - Fax:574-825-2212
Practice Address - Street 1:56853 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9536
Practice Address - Country:US
Practice Address - Phone:574-825-2211
Practice Address - Fax:574-825-2212
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOSHEN PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty