Organization
PRIVIA MEDICAL GROUP INDIANA, LLC
Active
Other names
Elkhart Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS VANDERGRIFT (CEO)
(574) 296-3200
Entity
Organization
Contact information
Practice address
2222 W LEXINGTON AVE, SUITE B, ELKHART, IN 46514-1420
(574) 296-3200
(574) 296-3392
Mailing address
303 S NAPPANEE ST, ELKHART, IN 46514-2066
(574) 296-3200
(574) 296-3392
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
10/18/2016
Last updated
05/12/2025
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