The South Bend Clinic LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

THE SOUTH BEND CLINIC LLC

Practice address

52500 Fir Rd
Granger, IN 46530-8579

Phone

(574) 271-0700

NPI assigned

Jul 30, 2021

Last updated

Mar 22, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Lynn Hiler

Title

Credentialing Coordinator

Phone

(574) 239-1567

Specialties & licenses 1

Addresses

Other names 1

• The South Bend Clinic Granger Family Medicine Other name

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

{
    "created_epoch": "1627603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1235802612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 UNIVERSITY COMMONS STE 230",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351590",
            "telephone_number": "574-239-1567",
            "fax_number": "574-239-1458"
        },
        {
            "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": "574-271-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SOUTH BEND CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-30",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "status": "A",
        "authorized_official_last_name": "HILER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "574-239-1567"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The South Bend Clinic Granger Family Medicine",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "The South Bend Clinic Granger Family Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kurt Allan Taulbee, LLP MASTERS
• Nicole Marie Taulbee, M.A., L.M.H.C., LPC
• Lisa Ann Walczak Thain, PHARMD
• The Cove Counseling LLC
• The South Bend Clinic LLC (The South Bend Clinic Pharmacy at Granger)
• Lori Kaye Thompson, MA CCC SLP
• Thrivemore Therapy, LLC
• Time to Talk, LLC
• Jessica Tomasi
• Rhonda M. Tomenko, PH.D.

• Durable Medical Equipment & Medical Supplies in Granger, IN
• Providers in Granger, IN by specialty
• Durable Medical Equipment & Medical Supplies in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; 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.