Healthcare Provider Details

I. General information

NPI: 1699670604
Provider Name (Legal Business Name): ST JOSEPH HEALTH SYSTEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6515 STELLHORN RD
FORT WAYNE IN
46815-5436
US

IV. Provider business mailing address

702 VAN BUREN ST
FORT WAYNE IN
46802-3697
US

V. Phone/Fax

Practice location:
  • Phone: 260-479-3001
  • Fax: 260-479-3002
Mailing address:
  • Phone: 260-425-3000
  • Fax: 260-425-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: PAULA LALOR
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 629-215-3953