ICP PPO, LLC

SOUTH BEND, IN
NPI1407443617
Entity TypeOrganization
Authorized ContactKELLY MACKEN - MARBLE
President
218-393-1566
Organization Subpart ?No
Primary Taxonomy305R00000X Preferred Provider Organization
Additional Taxonomies174400000X Specialist
Enumeration Date2020-12-22
Last Update Date2020-12-22
Business Address
ICP PPO, LLC
211 N EDDY ST
SOUTH BEND, IN 46617-2808
Phone number: 574-234-8161
Mailing Address
ICP PPO, LLC
413 W MONTGOMERY XRD STE 602
SAVANNAH, GA 31406-3396
Phone number: 912-691-5711