Provider Demographics
NPI:1780915082
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:PO BOX 660376
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46266-0001
Mailing Address - Country:US
Mailing Address - Phone:574-523-3148
Mailing Address - Fax:574-523-3492
Practice Address - Street 1:600 EAST BLVD
Practice Address - Street 2:HEART CLINIC
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2483
Practice Address - Country:US
Practice Address - Phone:574-523-2750
Practice Address - Fax:574-389-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10-005017-1261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service