| Elkhart Clinic, Llc | |
|
303 S Nappanee St Elkhart IN 46514-2066 | |
| (574) 296-3200 | |
| (574) 296-3392 |
| Full Name | Elkhart Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 303 S Nappanee St, Elkhart, Indiana |
| Authorized Official Name and Position | Thomas Vandergrift (CHIEF EXECUTIVE ADMINISTRATOR) |
| Authorized Official Contact | 5742963200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elkhart Clinic, Llc Po Box 778985 Chicago IL 60677-8985 Ph: (574) 296-3200 | Elkhart Clinic, Llc 303 S Nappanee St Elkhart IN 46514-2066 Ph: (574) 296-3200 |
| NPI Number | 1013912286 |
|---|---|
| Provider Enumeration Date | 06/15/2005 |
| Last Update Date | 05/21/2024 |
| Medicare PECOS PAC ID | 2365341674 |
|---|---|
| Medicare Enrollment ID | O20090116000467 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013912286 | NPI | - | NPPES |
| 0359310001 | Other | IN | DMERC PTAN |
| 100466600A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (Indiana) | Primary |
| Provider Name | Emily A Mitchell |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1043537020 PECOS PAC ID: 0941519185 Enrollment ID: I20190626000574 |
| Provider Name | Matthew Deere |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1952797771 PECOS PAC ID: 5799107314 Enrollment ID: I20220627002334 |
Heart City Health Center Pharmacy Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 236 Simpson Ave, Elkhart, IN 46516 Phone: 574-970-1441 Fax: 574-970-1449 | |
Elkhart Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2117 W Lexington Ave, Elkhart, IN 46514 Phone: 574-296-3444 Fax: 574-296-3328 | |
Elkhart Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2222 W Lexington Ave, Suite B, Elkhart, IN 46514 Phone: 574-296-3200 Fax: 574-296-3392 | |
Activate Healthcare - Waste Away Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1621 W Beardsley Ave, Elkhart, IN 46514 Phone: 773-697-3144 | |
Beacon Medical Group, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1506 Osolo Rd Ste C, Elkhart, IN 46514 Phone: 574-266-6050 Fax: 574-262-8485 | |
Susan M Moore-riesbeck Do Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 28070 County Road 24, Elkhart, IN 46517 Phone: 574-273-8053 Fax: 574-273-8056 |