OrganizationActive
Privia Medical Group Indiana, LLC
NPI 1013912286 · Multi-Specialty Clinic/Center · Elkhart, IN
Provider details
- NPI number
- 1013912286
- Entity type
- Organization
- Primary specialty
- Multi-Specialty Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Thomas Vandergrift, Chief Executive Administrator(574) 296-3200
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
303 S Nappanee St
Elkhart, IN 46514-2066
Phone: (574) 296-3200
Fax: (574) 296-3392
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 778985
Chicago, IL 60677-8985
Registry dates
- Enumerated
- 2005-06-15
- Last updated
- 2025-04-17
- Certified
- 2025-04-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.