| Elkhart Clinic, Llc | |
|
1904 Lake Ave Plymouth IN 46563-7828 | |
| (574) 296-3200 | |
| (574) 296-3392 |
| Full Name | Elkhart Clinic, Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1904 Lake Ave, Plymouth, Indiana |
| Authorized Official Name and Position | Kevin R. Boyer (CHIEF EXECUTIVE ADMINISTRATOR) |
| Authorized Official Contact | 5742963200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elkhart Clinic, Llc Po Box 2968 Elkhart IN 46515-2968 Ph: (574) 296-3200 | Elkhart Clinic, Llc 1904 Lake Ave Plymouth IN 46563-7828 Ph: (574) 296-3200 |
| NPI Number | 1821329723 |
|---|---|
| Provider Enumeration Date | 01/18/2010 |
| Last Update Date | 05/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821329723 | NPI | - | NPPES |
| 0359310001 | Other | IN | DMERC |
| CJ0814 | Other | IN | RR MEDICARE |
| 100466600F | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Byron M. Holm, Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2855 Miller Dr, Suite 117, Plymouth, IN 46563 Phone: 574-936-7777 Fax: 574-941-1072 | |
Proactive Md Plymouth Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 504 Colonial Ct, Plymouth, IN 46563 Phone: 812-645-1892 | |
Lifeplex Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2855 Miller Dr Ste 117, Plymouth, IN 46563 Phone: 574-936-7777 Fax: 574-941-1072 | |
Saint Joseph Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2349 Lake Ave Ste 99, Plymouth, IN 46563 Phone: 574-948-5340 Fax: 574-948-5494 | |
Family Medicine Center Of Plymouth Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 105 Water St, Plymouth, IN 46563 Phone: 574-936-3178 Fax: 574-936-1084 | |
Holm Medical Clinic Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2855 Miller Dr Ste 205, Plymouth, IN 46563 Phone: 574-286-0200 | |
Saint Joseph Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1919 Lake Ave Ste 102b, Plymouth, IN 46563 Phone: 574-335-6800 Fax: 574-948-5480 |