Healthcare Provider Details

I. General information

NPI: 1861598773
Provider Name (Legal Business Name): WARSAW HEALTH SYSTEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 PROVIDENT DR SUITE A
WARSAW IN
46580-3266
US

IV. Provider business mailing address

PO BOX 996
WARSAW IN
46581-0996
US

V. Phone/Fax

Practice location:
  • Phone: 574-372-5823
  • Fax:
Mailing address:
  • Phone: 574-372-5823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA HURLEY
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 214-473-3993