MEDICARE: GOSHEN HEALTH SYSTEM, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1356183032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOSHEN HEALTH SYSTEM, INC

Provider Business Mailing Address
First Line	:	PO BOX 834
Second Line	:
City	:	GOSHEN
State	:	IN
Zip	:	46527-0834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	226 W US HIGHWAY 20
Second Line	:
City	:	MIDDLEBURY
State	:	IN
Zip	:	46540-9713
Country	:	US
Telephone Number	:	574-825-8068
Fax Number	:	574-825-4873

Authorized Official
Title or Position	:	VP
Name	:	JONATHAN J YODER
Credential	:
Telephone Number	:	574-364-2560

Provider Enumeration Date	:	06/12/2024
Last Update Date	:	06/12/2024

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Directions to “GOSHEN HEALTH SYSTEM, INC ” Practice Location

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