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Organization

SOUTH BEND MEDICAL FOUNDATION, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TERRY PIPP (CFO)
(574) 234-7176
Entity
Organization

Contact information

Practice address
3355 DOUGLAS RD, SOUTH BEND, IN 46635-1779
(574) 234-4176
Mailing address
5700 SOUTHWYCK BLVD, TOLEDO, OH 43614-1509
(800) 288-8325
(419) 866-5453

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
291U00000X
Clinical Medical Laboratory

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000097080
ANTHEM
05
100112700A
IN
05
169513624
MI
01
1H1003494
TRICARE
01
690164004
RAILROAD MEDICARE
01
CB4553
RAILROAD MEDICARE
Enumeration date
02/01/2006
Last updated
08/28/2025
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