The South Bend Clinic LLP

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

THE SOUTH BEND CLINIC LLP

Doing business as

The South Bend Clinic Laboratory

Practice address

211 N Eddy St
South Bend, IN 46617-3096

Phone

(574) 237-9338

Fax

(574) 237-9215

NPI assigned

Jan 27, 2021

Organization subpart

No

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

Authorized official

Name

Kelly E Macken-Marble

Title

Ceo

Phone

(574) 239-1450

Specialties & licenses 1

Addresses

Other names 1

• The South Bend Clinic Laboratory Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

  • Clinic Pharmacy
  • Granger, IN
  • NPI 1174187553
  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

  • 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": "1611705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611705600000",
    "number": "1528659216",
    "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": "574-237-9338",
            "fax_number": "574-237-9215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 N EDDY ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466173096",
            "telephone_number": "574-237-9338",
            "fax_number": "574-237-9215"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 E Day Rd",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465453455",
            "country_code": "US",
            "telephone_number": "574-237-9338",
            "fax_number": "574-237-9215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE SOUTH BEND CLINIC LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-27",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-20",
        "status": "A",
        "authorized_official_last_name": "MACKEN-MARBLE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "574-239-1450"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The South Bend Clinic Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• The Nexus Center
• The South Bend Clinic LLC
• The South Bend Clinic LLC
• The South Bend Clinic LLC
• The South Bend Clinic LLC
• The South Bend Clinic LLP
• The South Bend Clinic Pharmacy
• The South Bend Clinic, LLC
• The Venus Home Care-Indiana LLC
• Michael Joseph Theall, LMHC

• Clinical Medical Laboratory in South Bend, IN
• Providers in South Bend, IN by specialty
• Clinical Medical Laboratory in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.