Organization
PRIVIA MEDICAL GROUP INDIANA, LLC
Active
Organization
PRIVIA MEDICAL GROUP INDIANA, LLC
Active
Other names
Primary Care at Mishawaka, Narcysia Health Care
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
410 PARK PL STE A, MISHAWAKA, IN 46545-3557
(574) 252-0667
(574) 807-8845
Mailing address
410 PARK PL, SUITE A, MISHAWAKA, IN 46545-3557
(574) 252-0667
(574) 807-8845
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100466600
—
IN
Enumeration date
09/15/2006
Last updated
05/12/2025
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