NPIMap

Organization Active NPI

Goshen Surgical Associates, Inc.

  • Vascular Surgery Physician
  • Goshen, IN
National Provider Identifier
1093823908
Registry record updated Jan 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
50001564A Issued in IN
Legal business name
GOSHEN SURGICAL ASSOCIATES, INC.
Practice address
101 Marilyn Ave
Suite 4
Goshen, IN 46526-4800
Phone
(574) 533-2769
Fax
(574) 534-6822
NPI assigned
Aug 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John W Harley, MDNPI 1649252388
Title
Vice President
Phone
(574) 533-2769

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X 50001564A IN
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X 50001564A IN Primary

Addresses

Primary practice location

101 Marilyn Ave
Suite 4
Goshen, IN 46526-4800

Mailing address

101 Marilyn Ave
Suite 4
Goshen, IN 46526-4800
Phone (574) 533-2769

Other identifiers 1

IdentifierTypeStateIssuer
100384730MedicaidIN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295827200000",
    "number": "1093823908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MARILYN AVE",
            "address_2": "SUITE 4",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465264800",
            "telephone_number": "574-533-2769",
            "fax_number": "574-534-6822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MARILYN AVE",
            "address_2": "SUITE 4",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465264800",
            "telephone_number": "574-533-2769",
            "fax_number": "574-534-6822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOSHEN SURGICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2011-01-24",
        "status": "A",
        "authorized_official_last_name": "HARLEY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "574-533-2769",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "IN",
            "license": "50001564A",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "IN",
            "license": "50001564A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100384730",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goshen, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.