MEMORIAL HOSPITAL OF SOUTH BEND, INC
NPI 1134534456
Physician Assistant in South Bend, IN

Q: What is Memorial Hospital Of South Bend, Inc's NPI number?

The NPI number for Memorial Hospital Of South Bend, Inc is 1134534456. It was assigned to this organization in the NPPES registry on June 25, 2014.

Q: What is Memorial Hospital Of South Bend, Inc's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Active since June 25, 2014CLIA 15D0920001 · Waiver

403 E MADISON ST, SOUTH BEND, IN 46617(574) 647-8400(574) 647-8410 Get Directions Write a Review

NPPES record last updated: June 25, 2014. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Memorial Hospital Of South Bend, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MEMORIAL HOSPITAL OF SOUTH BEND, INC (NPI 1134534456) is a healthcare organization registered as a physician assistant in South Bend, Indiana and active in the NPI registry since June 2014. The organization holds a CLIA Waiver certificate valid through May 4, 2028 and lists Jeffery P Costello, Vp/cfo, as its authorized official.

NPPES Registry Identity

NPI1134534456

Entity TypeOrganization

Primary Taxonomy363A00000X

Legal Business NameMEMORIAL HOSPITAL OF SOUTH BEND, INC

Location Address403 E MADISON STSouth Bend, IN 46617-2322

Mailing Address615 N Michigan StSouth Bend, IN 46601-1033

Phone(574) 647-8400

Fax(574) 647-8410

Organization SubpartNo

Authorized OfficialJeffery P CostelloVp/cfo · (574) 647-3549

Enumeration DateJune 25, 2014

✔ NPI 1134534456 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Also ListedGeneral Acute Care HospitalTaxonomy 282N00000X

403 E MADISON ST, South Bend, IN 46617

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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D0920001

Memorial Hospital Of South Bend · South Bend, IN

Active · expires May 4, 2028

CLIA Number15D0920001

Laboratory TypeHospital

Certificate Effective DateMay 5, 2026

Certificate Expiration DateMay 4, 2028

Laboratory DirectorMichelle Thompson

Laboratory Phone(574) 647-3370

Laboratory LocationMemorial Hospital Of South Bend615 N Michigan St, South Bend, IN 46601

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ALICE GOERTZ MSW

Social Worker