| Dr Scott Alan Blickensderfer, DO | |
|
6301 University Commons, Ste 350, South Bend, IN 46635-1571 | |
| (574) 234-4100 | |
| (574) 282-1739 |
| Full Name | Dr Scott Alan Blickensderfer |
|---|---|
| Gender | Male |
| Speciality | Urology |
| Experience | 39 Years |
| Location | 6301 University Commons, South Bend, Indiana |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578568572 | NPI | - | NPPES |
| 0000000234054 | Other | ANTHEM | |
| 264180V | Other | IN | MEDICARE PTAN |
| 100093110 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | 02001398A (Indiana) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Memorial Hospital Of South Bend | South bend, IN | Hospital |
| Saint Joseph Regional Medical Center - Plymouth | Plymouth, IN | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| The South Bend Clinic Llc | 3779577937 | 160 |
| Entity Name | The South Bend Clinic Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073680419 PECOS PAC ID: 3779577937 Enrollment ID: O20040412000439 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Scott Alan Blickensderfer, DO 6301 University Commons, Ste 230, South Bend, IN 46635-1571 Ph: (574) 251-2100 | Dr Scott Alan Blickensderfer, DO 6301 University Commons, Ste 350, South Bend, IN 46635-1571 Ph: (574) 234-4100 |
Dr. Arthur Philip Depauw, M.D. Urology Medicare: Not Enrolled in Medicare Practice Location: 6301 University Commons, Ste 350, South Bend, IN 46635 Phone: 574-234-4100 Fax: 574-282-1739 | |
Roger William Jump Iii, D.O. Urology Medicare: Accepting Medicare Assignments Practice Location: 6301 University Commons, Suite 350, South Bend, IN 46635 Phone: 574-234-4800 Fax: 574-282-1739 | |
Dr. Kathleen Marie Delnay, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 211 N Eddy St, South Bend, IN 46617 Phone: 574-234-4100 Fax: 574-282-1739 | |
Dr. John Anthony Hudak, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 6301 University Commons, Ste 350, South Bend, IN 46635 Phone: 574-234-4100 Fax: 574-282-1739 | |
Jeffrey C Cooper, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 211 N Eddy St, South Bend, IN 46617 Phone: 574-243-4450 Fax: 574-243-4405 | |
Dr. Mark Ernest Toth, M.D. Urology Medicare: Not Enrolled in Medicare Practice Location: 100 Navarre Pl, Ste. 4400, South Bend, IN 46601 Phone: 574-647-4535 |