| Primary Care At Mishawaka | |
|
410 Park Pl Suite B Mishawaka IN 46545-3557 | |
| (574) 855-5800 | |
| (574) 855-5805 |
| Full Name | Primary Care At Mishawaka |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 410 Park Pl, Mishawaka, Indiana |
| Authorized Official Name and Position | Timothy Porsche (MANAGING PARTNER) |
| Authorized Official Contact | 5742963200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care At Mishawaka Po Box 2968 Elkhart IN 46515-2968 Ph: (574) 296-3200 | Primary Care At Mishawaka 410 Park Pl Suite B Mishawaka IN 46545-3557 Ph: (574) 855-5800 |
| NPI Number | 1235303165 |
|---|---|
| Provider Enumeration Date | 04/22/2008 |
| Last Update Date | 07/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235303165 | NPI | - | NPPES |
| 100466600D | Medicaid | IN | |
| 0359310002 | Other | IN | MEDICARE NSC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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