Amanda Bates, MS ED
Individual provider Active NPI Contractor · South Bend, IN
NPI 1265974802 · NPPES record last updated Nov 14, 2016
Key facts
- NPI
- 1265974802
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 10136107 (IN)
- Practice address
- 1251 N Eddy St
Suite 200
South Bend, IN 46617-1479 - Phone
- (574) 406-1808
- NPI assigned
- Nov 14, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10136107 | IN | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 10136107 | IN | Yes |
Addresses
Primary practice location
1251 N Eddy St
Suite 200
South Bend, IN 46617-1479
Mailing address
PO Box 694
South Bend, IN 46624-0694
Phone (574) 406-1808
Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.