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General NPI Number Information
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NPI Number | 1043288111
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Entity Type | Organization
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Legal Business Name | GOSHEN AMBULATORY CARE CENTER LLC
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 1605 WINSTED DR
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City | GOSHEN
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State | IN
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Zip | 46526-4655
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Country | US
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Telephone | 574-534-8794
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Fax | 574-534-3082
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Provider Business Mailing Address
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Address Line | 1605 WINSTED DR
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City | GOSHEN
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State | IN
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Zip | 46526-4655
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Country | US
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Telephone | 574-534-8794
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Fax | 574-534-3082
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | DEBORAH STARNES
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Credential |
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Telephone | 574-534-8794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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