| Privia Medical Group Indiana, Llc | |
|
2222 W Lexington Ave Suite B Elkhart IN 46514-1420 | |
| (574) 296-3200 | |
| (574) 296-3392 |
| Full Name | Privia Medical Group Indiana, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2222 W Lexington Ave, Elkhart, Indiana |
| Authorized Official Name and Position | Thomas Vandergrift (CEO) |
| Authorized Official Contact | 5742963200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Privia Medical Group Indiana, Llc 303 S Nappanee St Elkhart IN 46514-2066 Ph: (574) 296-3200 | Privia Medical Group Indiana, Llc 2222 W Lexington Ave Suite B Elkhart IN 46514-1420 Ph: (574) 296-3200 |
| NPI Number | 1083165708 |
|---|---|
| Provider Enumeration Date | 10/18/2016 |
| Last Update Date | 05/12/2025 |
| Medicare PECOS PAC ID | 2365341674 |
|---|---|
| Medicare Enrollment ID | O20250319003886 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083165708 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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Privia Medical Group Indiana, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 303 S Nappanee St, Elkhart, IN 46514 Phone: 574-296-3200 Fax: 574-296-3392 | |
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