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General NPI Number Information
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NPI Number | 1780564781
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Entity Type | Organization
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Legal Business Name | MEMORIAL HOSPITAL OF SOUTH BEND
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 615 N MICHIGAN ST
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City | SOUTH BEND
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State | IN
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Zip | 46601-1033
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Country | US
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Telephone | 574-647-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 3245 HEALTH DR STE 100
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City | GRANGER
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State | IN
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Zip | 46530-1380
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Country | US
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Telephone | 574-647-1070
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JEFFREY COSTELLO
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Credential |
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Telephone | 574-647-3460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number |
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License Number State |
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