The South Bend Clinic LLC

Primary specialty

Clinic PharmacyTaxonomy code 3336C0002X

Legal business name

THE SOUTH BEND CLINIC LLC

Doing business as

The South Bend Clinic Pharmacy at Granger

Practice address

52500 Fir Rd
Granger, IN 46530-8579

Phone

(574) 204-7260

NPI assigned

May 1, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andrea Krupa

Title

Exec Directory of Pharmacy

Phone

(574) 239-1461

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The South Bend Clinic Pharmacy at Granger Doing business as

Tax ID family

Ironwood Medical Group9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

• Family Care Associates

  • Family Medicine Physician
  • South Bend, IN
  • NPI 1225019219
  NPD tax ID
• The South Bend Clinic LLC

  • Durable Medical Equipment & Medical Supplies
  • Mishawaka, IN
  • NPI 1124791587
  NPD tax ID
• The South Bend Clinic LLC

  • Durable Medical Equipment & Medical Supplies
  • South Bend, IN
  • NPI 1538832910
  NPD tax ID
• The South Bend Clinic LLC

  • Durable Medical Equipment & Medical Supplies
  • South Bend, IN
  • NPI 1891468278
  NPD tax ID
• The South Bend Clinic LLP

  dba The South Bend Clinic Laboratory

  • Clinical Medical Laboratory
  • South Bend, IN
  • NPI 1528659216
  NPD tax ID
• The South Bend Clinic LLP

  • Clinic/Center
  • South Bend, IN
  • NPI 1538257167
  NPD tax ID
• The South Bend Clinic Pharmacy

  • Pharmacist
  • South Bend, IN
  • NPI 1144357328
  NPD tax ID
• The South Bend Clinic, LLC

  • Anesthesiology Physician
  • South Bend, IN
  • NPI 1487307492
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1174187553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 N EDDY ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466173096",
            "telephone_number": "574-237-9295",
            "fax_number": "574-239-1554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52500 FIR RD",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465308579",
            "telephone_number": "574-204-7260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SOUTH BEND CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-01",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "KRUPA",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "EXEC DIRECTORY OF PHARMACY",
        "authorized_official_telephone_number": "574-239-1461"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100300930",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The South Bend Clinic Pharmacy at Granger",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic Pharmacy in Granger, IN
• Providers in Granger, IN by specialty
• Clinic Pharmacy in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.