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Organization

ELKHART CLINIC ASC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. KEVIN R. BOYER (CHIEF EXECUTIVE OFFICER)
(574) 296-3200
Entity
Organization

Contact information

Practice address
2117 W LEXINGTON AVE, ELKHART, IN 46514-1423
(574) 296-3437
(574) 296-3447
Mailing address
PO BOX 2997, ELKHART, IN 46515-2997
(574) 296-3437
(574) 296-3447

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
04-003903-1
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200263270A
IN
Enumeration date
06/15/2005
Last updated
04/29/2014
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