<Unavail>

LBN: The South Bend Clinic Llc
<Unavail> is an health care organization with primary practice located at 52500 Fir Rd , Granger IN 46530-8579. The organization recently has only one registered license in Suppliers / Clinic Pharmacy, which is considered as the primary health care specialty. The South Bend Clinic Llc can be contacted via phone (574) 204-7260, or through Krupa, Andrea via phone (574) 239-1461.

Contact Information

Primary practice address
52500 Fir Rd Granger IN 46530-8579
Phone: (574) 204-7260
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Krupa, Andrea
Phone: (574) 239-1461

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Clinic Pharmacy 3336C0002X

Profile Details

NPI number 1174187553
LBN Legal business name The South Bend Clinic Llc
DBA Doing business as <Unavail>
Authorized official Krupa, Andrea
Entity Organization
Organization subpart 1 No
Enumeration date May 1st, 2019
Last updated Nov 26th, 2024 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174187553 NPPES
Indiana MEDICAID 100300930

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