Provider Demographics
NPI:1174571129
Name:SAINT JOSEPH REGIONAL MEDICAL CENTER- PLYMOUTH CAMPUS INC
Entity type:Organization
Organization Name:SAINT JOSEPH REGIONAL MEDICAL CENTER- PLYMOUTH CAMPUS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KARAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-335-5000
Mailing Address - Street 1:5215 HOLY CROSS PKWY
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1469
Mailing Address - Country:US
Mailing Address - Phone:574-335-5000
Mailing Address - Fax:
Practice Address - Street 1:1915 LAKE AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-9366
Practice Address - Country:US
Practice Address - Phone:574-948-4000
Practice Address - Fax:574-948-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-005070-1282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN214441600OtherACS FEDERAL EMPLOYEES WC
IN000000097821OtherBLUE CROSS
IN100269590AMedicaid
IN150076Medicare Oscar/Certification