Organization
PRIVIA MEDICAL GROUP INDIANA, LLC
Active
Organization
PRIVIA MEDICAL GROUP INDIANA, LLC
Active
Other names
Primary Care at Mishawaka, Edison Lakes Urology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY PORSCHE (MANAGING PARTNER)
(574) 296-3200
Entity
Organization
Contact information
Practice address
410 PARK PL, SUITE B, MISHAWAKA, IN 46545-3557
(574) 855-5800
(574) 855-5805
Mailing address
PO BOX 2968, ELKHART, IN 46515-2968
(574) 296-3200
(574) 296-3392
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0359310002
MEDICARE NSC
IN
05
—
100466600D
—
IN
Enumeration date
04/22/2008
Last updated
05/12/2025
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up