Healthcare Provider Details

I. General information

NPI: 1154440675
Provider Name (Legal Business Name): EARLHAM COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 NATIONAL RD W HEALTH SERVICES
RICHMOND IN
47374-4021
US

IV. Provider business mailing address

801 NATIONAL RD W HEALTH SERVICES
RICHMOND IN
47374-4021
US

V. Phone/Fax

Practice location:
  • Phone: 765-983-1328
  • Fax: 765-983-1488
Mailing address:
  • Phone: 765-983-1328
  • Fax: 765-983-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number01025101
License Number StateIN

VIII. Authorized Official

Name: DR. HOWARD CHRISTOPHER DEITSCH
Title or Position: PHYSICIAN
Credential: MD
Phone: 765-983-1328