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Organization
ST. JOSEPH PRIMARY CARE LLC
Active
Organization
ST. JOSEPH PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. THERESA L OYLER (REGIONAL PRACTICE ADMINISTRATOR)
(765) 457-8381
Entity
Organization
Contact information
Practice address
1907 W SYCAMORE ST, KOKOMO, IN 46901-5148
(765) 457-8381
(765) 457-4443
Mailing address
3109 W SYCAMORE ST, KOKOMO, IN 46901-4181
(765) 457-8381
(765) 457-4443
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000183506
BLUE CROSS BLUE SHIELD GR
IN
Enumeration date
07/25/2007
Last updated
07/25/2007
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