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Organization
ST JOSEPH MEDICAL GROUP INC
Active
Organization
ST JOSEPH MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7626
Entity
Organization
Contact information
Practice address
1109 W MAUMEE ST, ANGOLA, IN 46703-1329
(260) 665-2131
Mailing address
1109 W MAUMEE ST, ANGOLA, IN 46703-1329
(260) 665-2131
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
NULL
208D00000X
General Practice Physician
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
04/20/2006
Last updated
06/25/2008
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