Healthcare Provider Details

I. General information

NPI: 1477551489
Provider Name (Legal Business Name): ELKHART GENERAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST BLVD
ELKHART IN
46514-2483
US

IV. Provider business mailing address

600 EAST BLVD
ELKHART IN
46514-2483
US

V. Phone/Fax

Practice location:
  • Phone: 574-523-3200
  • Fax: 574-523-3492
Mailing address:
  • Phone: 574-294-2621
  • Fax: 574-523-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number05-005017-1
License Number StateIN

VIII. Authorized Official

Name: MR. JEFFREY COSTELLO
Title or Position: CFO
Credential:
Phone: 574-647-3460