Organization
PRIVIA MEDICAL GROUP INDIANA, LLC
Active
Parent organization
ELKHART CLINIC, LLC
Other names
Elkhart Clinic Wakarusa
Organization subpart
Yes
Provider details
NPI number
Legal business name
ELKHART CLINIC, LLC
Authorized official
MEGAN LEIGH CARLSON (PROVIDER ENROLLMENT)
(574) 296-3991
Entity
Organization
Contact information
Practice address
100 N. ELKHART ST, WAKARUSA, IN 46573
(574) 296-3200
Mailing address
PO BOX 778985, CHICAGO, IL 60677-8985
(574) 296-3390
(574) 296-3392
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/15/2023
Last updated
05/12/2025
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