OrganizationActive
Privia Medical Group Indiana, LLC
NPI 1235303165 · Multi-Specialty Clinic/Center · Mishawaka, IN
Provider details
- NPI number
- 1235303165
- Entity type
- Organization
- Primary specialty
- Multi-Specialty Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Timothy Porsche, Managing Partner(574) 296-3200
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
410 Park Pl
Suite B
Mishawaka, IN 46545-3557
Phone: (574) 855-5800
Fax: (574) 855-5805
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 2968
Elkhart, IN 46515-2968
Other names (DBA / former)
- Other name
- Edison Lakes Urology
- Other name
- Primary Care at Mishawaka
Registry dates
- Enumerated
- 2008-04-22
- Last updated
- 2025-05-12
- Certified
- 2025-05-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.