# ST JOSEPH PRIMARY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Med One Of St Joseph
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073569364
- **Authorized official:** ANDREW KELLAR (REGIONAL PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (765) 457-8381

## Contact information

- **Practice address:** 5111 CLINTON DR, KOKOMO, IN 46902-7136
- **Practice address phone:** (765) 453-8800
- **Practice address fax:** (765) 457-4443
- **Mailing address:** 5111 CLINTON DR, KOKOMO, IN 46902-7136
- **Mailing address phone:** (765) 453-8800
- **Mailing address fax:** (765) 457-4443

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | IN | — |
| 261QU0200X | Urgent Care Clinic/Center | — | IN | Yes |

## Other

- **Enumeration date:** 05/26/2006
- **Last updated:** 11/16/2007