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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
SOPHIA L ARWOOD (DIRECTOR OF PHYSICIAN OPERATIONS)
(615) 628-6038
Entity
Organization
Contact information
Practice address
2622 LAKE AVE, FORT WAYNE, IN 46805-5410
(260) 425-3100
Mailing address
2622 LAKE AVE, FORT WAYNE, IN 46805-5410
(260) 425-3100
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
NULL
104100000X
Social Worker
—
—
207K00000X
Allergy & Immunology Physician
—
NULL
207K00000X
Allergy & Immunology Physician
—
—
207L00000X
Anesthesiology Physician
—
NULL
207L00000X
Anesthesiology Physician
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
NULL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
NULL
207RH0003X
Hematology & Oncology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
NULL
207RP1001X
Pulmonary Disease Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100268520
—
IN
05
—
2629570
—
OH
Enumeration date
04/19/2006
Last updated
12/15/2015
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