MEDICARE: SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QI0500X	Infusion Therapy Clinic/Center

General Provider Information

NPI Number	:	1811844590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC.

Provider Business Mailing Address
First Line	:	1919 LAKE AVE STE 97B
Second Line	:
City	:	PLYMOUTH
State	:	IN
Zip	:	46563-7830
Country	:	US
Telephone Number	:	574-948-4420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 LAKE AVE STE 97B
Second Line	:
City	:	PLYMOUTH
State	:	IN
Zip	:	46563-7830
Country	:	US
Telephone Number	:	574-948-4420
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT
Name	:	CHERYL SWIHART
Credential	:
Telephone Number	:	574-335-8717

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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