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General NPI Number Information
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NPI Number | 1528659216
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Entity Type | Organization
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Legal Business Name | THE SOUTH BEND CLINIC LLP
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 211 N EDDY ST
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City | SOUTH BEND
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State | IN
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Zip | 46617-3096
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Country | US
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Telephone | 574-237-9338
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Fax | 574-237-9215
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Provider Business Mailing Address
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Address Line | 211 N EDDY ST
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City | SOUTH BEND
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State | IN
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Zip | 46617-3096
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Country | US
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Telephone | 574-237-9338
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Fax | 574-237-9215
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Authorized Official
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Title or Position | CEO
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Name | KELLY E MACKEN-MARBLE
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Credential |
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Telephone | 574-239-1450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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