| Organization Name: | ELKHART CLINIC, LLC |
| NPI Number: | 1013912286 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN R. BOYER (CHIEF EXECUTIVE ADMINISTRATOR) |
| Mailing Address: | 303 S Nappanee St Elkhart |
| State: | IN US |
| Postal Code: | 465142066 |
| Phone Number: | 5742963200 |
| Fax Number: | 5742963392 |
| NPI Enumeration Date: | 06/15/2005 |
| NPI Last Update Date: | 04/30/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |