# MEMORIAL HOSPITAL OF SOUTH BEND, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134534456
- **Authorized official:** MR. JEFFERY P COSTELLO (VP/CFO)
- **Authorized official phone:** (574) 647-3549

## Contact information

- **Practice address:** 403 E MADISON ST, SOUTH BEND, IN 46617-2322
- **Practice address phone:** (574) 647-8400
- **Practice address fax:** (574) 647-8410
- **Mailing address:** 615 N MICHIGAN ST, SOUTH BEND, IN 46601-1033

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | — | NULL | — |
| 363A00000X | Physician Assistant | — | NULL | Yes |
| 363A00000X | Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 06/25/2014
- **Last updated:** 09/09/2014