Organization
ST JOSEPH PRIMARY LLC
Active
Other names
Med One Of St Joseph
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW KELLAR (REGIONAL PRACTICE ADMINISTRATOR)
(765) 457-8381
Entity
Organization
Contact information
Practice address
5111 CLINTON DR, KOKOMO, IN 46902-7136
(765) 453-8800
(765) 457-4443
Mailing address
5111 CLINTON DR, KOKOMO, IN 46902-7136
(765) 453-8800
(765) 457-4443
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
IN
261QU0200X
Urgent Care Clinic/Center
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000183506
BLUE CROSS BLUE SHIELD
IN
05
—
20031200
—
IN
Enumeration date
05/26/2006
Last updated
11/16/2007
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