Provider Demographics
NPI:1841245594
Name:SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC.
Entity Type:Organization
Organization Name:SAINT JOSEPH REGIONAL MEDICAL CENTER-SOUTH BEND CAMPUS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:SINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-335-5000
Mailing Address - Street 1:707 CEDAR ST STE 200
Mailing Address - Street 2:SAINT JOSEPH HEALTH SYSTEM PROVIDER SERVICES
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2057
Mailing Address - Country:US
Mailing Address - Phone:574-335-8700
Mailing Address - Fax:574-335-0760
Practice Address - Street 1:5215 HOLY CROSS PKWY
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1469
Practice Address - Country:US
Practice Address - Phone:574-335-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0700X, 261QM1200X, 261QP2000X, 261QR0200X, 261QX0100X
IN06-005012-2282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100269940AMedicaid
IN128639800OtherACS FEDERAL EMPLOYEES WC
MI405172554Medicaid
IN000000097679OtherANTHEM/BLUE CROSS
IN030181000OtherBLACK LUNG
IN150012B000000OtherSECTION 1011
MI309506586Medicaid
MI309506586Medicaid
IN000000097679OtherANTHEM/BLUE CROSS
IN030181000OtherBLACK LUNG
IN000000097679OtherANTHEM/BLUE CROSS
IN941050Medicare PIN