Healthcare Provider Details

I. General information

NPI: 1629757356
Provider Name (Legal Business Name): HEALTH PLUS INDIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S WILLIAM ST
SOUTH BEND IN
46601-2515
US

IV. Provider business mailing address

201 S WILLIAM ST
SOUTH BEND IN
46601-2515
US

V. Phone/Fax

Practice location:
  • Phone: 574-534-2870
  • Fax:
Mailing address:
  • Phone: 574-234-2870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LEEAH HOPPER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 574-234-2870