Healthcare Provider Details

I. General information

NPI: 1497905897
Provider Name (Legal Business Name): ELKHART GENERAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 N MAIN ST UNIT #34
GRANGER IN
46530-9680
US

IV. Provider business mailing address

6910 N MAIN ST UNIT #34
GRANGER IN
46530-9680
US

V. Phone/Fax

Practice location:
  • Phone: 574-277-7860
  • Fax: 574-277-7861
Mailing address:
  • Phone: 574-277-7860
  • Fax: 574-277-7861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01050228A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. C. JOHN KRAFT JR.
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 574-523-7914