Organization
THE SOUTH BEND CLINIC LLC
Active
Other names
South Bend Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL J MEYER (EXECUTIVE DIRECTOR)
(574) 237-9201
Entity
Organization
Contact information
Practice address
211 N EDDY ST, SOUTH BEND, IN 46617-2808
(574) 299-2450
(574) 299-2415
Mailing address
6301 UNIVERSITY COMMONS STE 230, SOUTH BEND, IN 46635-1590
(574) 251-2115
(574) 251-2150
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
—
IN
291U00000X
Clinical Medical Laboratory
15D0357414
IN
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100442630
—
IN
Enumeration date
11/29/2006
Last updated
07/10/2024
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