Healthcare Provider Details

I. General information

NPI: 1588190284
Provider Name (Legal Business Name): GOSHEN HEALTH SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 DORCHESTER CT
GOSHEN IN
46526
US

IV. Provider business mailing address

2004 ELKHART ROAD STE A
GOSHEN IN
46526
US

V. Phone/Fax

Practice location:
  • Phone: 574-534-2548
  • Fax: 574-534-3622
Mailing address:
  • Phone: 574-364-2611
  • Fax: 574-364-2784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD TARSKE
Title or Position: VICE PRESIDENT
Credential:
Phone: 574-364-2875