# GOSHEN SURGICAL ASSOCIATES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093823908
- **Authorized official:** JOHN W HARLEY MD (VICE PRESIDENT)
- **Authorized official phone:** (574) 533-2769

## Contact information

- **Practice address:** 101 MARILYN AVE, SUITE 4, GOSHEN, IN 46526-4800
- **Practice address phone:** (574) 533-2769
- **Practice address fax:** (574) 534-6822
- **Mailing address:** 101 MARILYN AVE, SUITE 4, GOSHEN, IN 46526-4800
- **Mailing address phone:** (574) 533-2769
- **Mailing address fax:** (574) 534-6822

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | 50001564A | IN | — |
| 2086S0129X | Vascular Surgery Physician | 50001564A | IN | Yes |

## Other

- **Enumeration date:** 08/29/2006
- **Last updated:** 01/24/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100384730 | — | IN |