Organization
INDIANA UNIVERSITY SOUTH BEND HEALTH & WELLNESS CENTER
Active
Organization
INDIANA UNIVERSITY SOUTH BEND HEALTH & WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIO ORTIZ RN; PHD; PHCNS-BC (DEAN AND PROFESSOR)
(574) 520-5557
Entity
Organization
Contact information
Practice address
941 20TH STREET, SOUTH BEND, IN 46634-7111
(574) 520-5557
(574) 520-5042
Mailing address
941 20TH STREET, SOUTH BEND, IN 46634-7111
(574) 520-5557
(574) 520-5042
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
28076706A
IN
164W00000X
Licensed Practical Nurse
28156667A
IN
207R00000X
Internal Medicine Physician
Primary
01046709
IN
302R00000X
Health Maintenance Organization
—
—
Other
Enumeration date
04/28/2014
Last updated
04/28/2014
Update your record
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