Healthcare Provider Details

I. General information

NPI: 1710729488
Provider Name (Legal Business Name): GOSHEN HEALTH SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 N INDIANA AVE
SYRACUSE IN
46567-1017
US

IV. Provider business mailing address

PO BOX 834
GOSHEN IN
46527-0834
US

V. Phone/Fax

Practice location:
  • Phone: 574-457-5701
  • Fax: 574-457-5609
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN J YODER
Title or Position: VP
Credential:
Phone: 574-364-2560