| Ihc At Michigan St | |
|
765 S Michigan St South Bend IN 46601-3101 | |
| (574) 235-7990 | |
| (574) 847-7200 |
| Full Name | Ihc At Michigan St |
|---|---|
| Speciality | Clinic/Center |
| Location | 765 S Michigan St, South Bend, Indiana |
| Authorized Official Name and Position | Tracy Nagel (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 3175761335 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ihc At Michigan St 8003 Castleway Dr Indianapolis IN 46250-1946 Ph: (317) 576-1335 | Ihc At Michigan St 765 S Michigan St South Bend IN 46601-3101 Ph: (574) 235-7990 |
| NPI Number | 1306957311 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 01/08/2024 |
| Medicare PECOS PAC ID | 3971599473 |
|---|---|
| Medicare Enrollment ID | O20061114000603 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306957311 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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