Organization
THE SOUTH BEND CLINIC LLC
Active
Other names
The South Bend Clinic Portage
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LYNN HILER (CREDENTIALING COORDINATOR)
(574) 239-1567
Entity
Organization
Contact information
Practice address
4440 PORTAGE AVE, SOUTH BEND, IN 46628-9570
(574) 204-6200
Mailing address
6301 UNIVERSITY COMMONS STE 230, SOUTH BEND, IN 46635-1590
(157) 423-9156
(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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