Organization
SOUTH BEND SPECIALTY SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RALPH E LANTZ RN BSN, MBA (ADMINISTRATOR)
(574) 606-6329
Entity
Organization
Contact information
Practice address
335 FLORENCE AVE, SUITE 1B, GRANGER, IN 46530-8049
(574) 217-0058
(574) 272-3901
Mailing address
335 FLORENCE AVE, SUITE 1B, GRANGER, IN 46530-8049
(574) 217-0058
(574) 272-3901
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
IN
Other
Enumeration date
10/23/2012
Last updated
07/17/2013
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