OrganizationActive
Icp Ppo, LLC
NPI 1407443617 · Preferred Provider Organization · South Bend, IN
Provider details
- NPI number
- 1407443617
- Entity type
- Organization
- Primary specialty
- Preferred Provider OrganizationManaged Care Organizations
- Organization subpart
- No
- Authorized official
- Kelly Macken - Marble, President(218) 393-1566
Specialties & taxonomies
Managed Care Organizations
- Specialist174400000X
Other Service Providers
Practice location
211 N Eddy St
South Bend, IN 46617-2808
Phone: (574) 234-8161
Approximate (ZIP-level) locationGet directions
Mailing address
413 W Montgomery Xrd Ste 602
Savannah, GA 31406-3396
Registry dates
- Enumerated
- 2020-12-22
- Last updated
- 2020-12-22
- Certified
- 2020-12-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.