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Organization
MEMORIAL HOSPITAL OF SOUTH BEND
Active
Organization
MEMORIAL HOSPITAL OF SOUTH BEND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY COSTELLO (CFO)
(574) 647-3460
Entity
Organization
Contact information
Practice address
615 N MICHIGAN ST, SOUTH BEND, IN 46601-1033
(574) 647-1000
Mailing address
615 N MICHIGAN ST, SOUTH BEND, IN 46601-1087
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
005053
IN
207RH0000X
Hematology (Internal Medicine) Physician
—
—
207RX0202X
Medical Oncology Physician
—
—
207VX0201X
Gynecologic Oncology Physician
—
—
2085R0001X
Radiation Oncology Physician
—
—
225X00000X
Occupational Therapist
005053
IN
261QC1500X
Community Health Clinic/Center
005053
IN
273R00000X
Psychiatric Hospital Unit
—
—
273Y00000X
Rehabilitation Hospital Unit
06-005053
IN
282N00000X
General Acute Care Hospital
Primary
06-005053
IN
332B00000X
Durable Medical Equipment & Medical Supplies
005053
IN
341600000X
Ambulance
—
—
3416A0800X
Air Ambulance
005053
IN
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000097671
ANTHEM PIN
IN
05
—
100239890A
—
IN
05
—
100269890B
—
IN
05
—
100269910A
—
IN
05
—
200318490A
—
IN
05
—
200378380A
—
IN
05
—
200713710A
—
IN
05
—
300133206
—
IN
Enumeration date
06/01/2006
Last updated
07/14/2026
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