Basic Information
| Provider Information | |||||||||
| NPI: | 1912982109 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBB | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | MARVIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 N MICHIGAN ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466011033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5746477167 | ||||||||
| FaxNumber: | 5746473671 | ||||||||
| Practice Location | |||||||||
| Address1: | 615 N MICHIGAN ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466011033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5746477167 | ||||||||
| FaxNumber: | 5746473671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2005 | ||||||||
| LastUpdateDate: | 01/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 01056419A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 01056419A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000315370 | 01 | IN | BCBS LAPORTE | OTHER | P01713005 | 01 | IN | RR-MEDICARE | OTHER | 200389510 | 05 | IN | MEDICAID | 000000315379 | 01 | IN | BCBS MEDPOINT MAIN STREET | OTHER | 000000294237 | 01 | IN | BCBS MEMORIAL HOSPITALIST | OTHER | 000000389171 | 01 | IN | BMG E BLAIR WARNER | OTHER | 000000878854 | 01 | IN | BCBS IRELAND RD | OTHER |