Organization
THE SOUTH BEND CLINIC LLC
Active
Other names
The South Bend Clinic Granger Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LYNN HILER (CREDENTIALING COORDINATOR)
(574) 239-1567
Entity
Organization
Contact information
Practice address
52500 FIR RD, GRANGER, IN 46530-8579
(574) 271-0700
Mailing address
6301 UNIVERSITY COMMONS STE 230, SOUTH BEND, IN 46635-1590
(574) 239-1567
(574) 239-1458
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
07/30/2021
Last updated
03/22/2022
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