| |
201 S William St South Bend IN 46601-2515 | |
(574) 534-2870 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 201 S William St, South Bend, Indiana |
Authorized Official Name and Position | Leeah Hopper (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 5742764859 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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201 S William St South Bend IN 46601-2515 Ph: (574) 234-2870 | 201 S William St South Bend IN 46601-2515 Ph: (574) 534-2870 |
NPI Number | 1629757356 |
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Provider Enumeration Date | 07/11/2023 |
Last Update Date | 08/01/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1629757356 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
2083P0901X | Preventive Medicine - Public Health & General Preventive Medicine | (* (Not Available)) | Secondary |
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