Organization
THE SOUTH BEND CLINIC LLP
Active
Parent organization
SOUTH BEND CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTH BEND CLINIC
Authorized official
MRS. KELLY E. MACKEN-MARBLE (EXECUTIVE DIRECTOR)
(574) 237-9201
Entity
Organization
Contact information
Practice address
211 N EDDY ST, SOUTH BEND, IN 46617-2808
(574) 246-8816
(574) 237-9309
Mailing address
PO BOX 715223, CINCINNATI, OH 45271-5223
(574) 299-2450
(574) 299-2415
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200266980A
—
IN
Enumeration date
10/10/2006
Last updated
01/10/2020
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