Organization
GOSHEN AMBULATORY CARE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH STARNES (OFFICE ADMINISTRATOR)
(574) 534-8794
Entity
Organization
Contact information
Practice address
1605 WINSTED DR, GOSHEN, IN 46526-4655
(574) 534-8794
(574) 534-3082
Mailing address
1605 WINSTED DR, GOSHEN, IN 46526-4655
(574) 534-8794
(574) 534-3082
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000185275
ANTHEM BCBS
IN
05
—
200258140
—
IN
01
—
490004601
RAILROAD MEDICARE
IN
Enumeration date
03/14/2006
Last updated
06/11/2008
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