# MEMORIAL HEALTH SYSTEM, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Memorial's Prenatal Clinic @ Olive Street
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902134521
- **Authorized official:** MR. JEFFREY P. COSTELLO (VP/CFO)
- **Authorized official phone:** (574) 647-3549

## Contact information

- **Practice address:** 244 S OLIVE ST, SUITE E, SOUTH BEND, IN 46619-2100
- **Practice address phone:** (574) 647-1600
- **Practice address fax:** (574) 237-6069
- **Mailing address:** 710 N NILES AVE, SOUTH BEND, IN 46617-1924
- **Mailing address phone:** (574) 647-1610

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 367A00000X | Advanced Practice Midwife | 09000186A | IN | Yes |

## Other

- **Enumeration date:** 11/19/2009
- **Last updated:** 03/09/2016