NPIMap

Organization Active NPI

The South Bend Clinic LLP

  • Clinic/Center
  • South Bend, IN
National Provider Identifier
1538257167
Registry record updated Jan 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
THE SOUTH BEND CLINIC LLP
Practice address
211 N Eddy St
South Bend, IN 46617-2808
Phone
(574) 246-8816
Fax
(574) 237-9309
NPI assigned
Oct 10, 2006
Organization subpart
Yes
Parent organization
SOUTH BEND CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 10, 2020

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

Authorized official

Name
Mrs. Kelly E. Macken-Marble
Title
Executive Director
Phone
(574) 237-9201

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Multi-Specialty Clinic/Center 261QM1300X
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

211 N Eddy St
South Bend, IN 46617-2808

Mailing address

PO Box 715223
Cincinnati, OH 45271-5223
Phone (574) 299-2450

Other identifiers 1

IdentifierTypeStateIssuer
200266980AMedicaidIN

National Provider Directory

National Provider Directory
Tax ID family
Ironwood Medical Group9 organizations share this tax ID, including this one
Part of
Ironwood Medical Group

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578614400000",
    "number": "1538257167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 715223",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452715223",
            "telephone_number": "574-299-2450",
            "fax_number": "574-299-2415"
        },
        {
            "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": "466172808",
            "telephone_number": "574-246-8816",
            "fax_number": "574-237-9309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SOUTH BEND CLINIC LLP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH BEND CLINIC",
        "enumeration_date": "2006-10-10",
        "last_updated": "2020-01-10",
        "certification_date": "2020-01-10",
        "status": "A",
        "authorized_official_last_name": "MACKEN-MARBLE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "574-237-9201",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200266980A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2020; 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.