Organization
GOSHEN SURGICAL ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN W HARLEY MD (VICE PRESIDENT)
(574) 533-2769
Entity
Organization
Contact information
Practice address
101 MARILYN AVE, SUITE 4, GOSHEN, IN 46526-4800
(574) 533-2769
(574) 534-6822
Mailing address
101 MARILYN AVE, SUITE 4, GOSHEN, IN 46526-4800
(574) 533-2769
(574) 534-6822
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
50001564A
IN
2086S0129X
Vascular Surgery Physician
Primary
50001564A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100384730
—
IN
Enumeration date
08/29/2006
Last updated
01/24/2011
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