# SOUTH BEND SPECIALTY SURGERY CENTER, LLC

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

## Provider details

- **NPI number:** 1992058325
- **Authorized official:** RALPH E LANTZ RN BSN, MBA (ADMINISTRATOR)
- **Authorized official phone:** (574) 606-6329

## Contact information

- **Practice address:** 335 FLORENCE AVE, SUITE 1B, GRANGER, IN 46530-8049
- **Practice address phone:** (574) 217-0058
- **Practice address fax:** (574) 272-3901
- **Mailing address:** 335 FLORENCE AVE, SUITE 1B, GRANGER, IN 46530-8049
- **Mailing address phone:** (574) 217-0058
- **Mailing address fax:** (574) 272-3901

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | IN | Yes |

## Other

- **Enumeration date:** 10/23/2012
- **Last updated:** 07/17/2013