Provider Demographics
NPI:1093954950
Name:COMMUNITY HEALTH PARTNERS OF SOUTH BEND, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH PARTNERS OF SOUTH BEND, INC.
Other - Org Name:BENDIX FAMILY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:IDEN
Authorized Official - Suffix:
Authorized Official - Credentials:BA, AS, CMA
Authorized Official - Phone:574-245-4980
Mailing Address - Street 1:PO BOX 3998
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46619-0998
Mailing Address - Country:US
Mailing Address - Phone:574-245-4980
Mailing Address - Fax:574-245-4981
Practice Address - Street 1:1010 N BENDIX DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-1925
Practice Address - Country:US
Practice Address - Phone:574-245-4980
Practice Address - Fax:574-245-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200949510AMedicaid
IN200949510AMedicaid