Organization
ST JOSEPH PRIMARY LLC
Active
Organization
ST JOSEPH PRIMARY LLC
Active
Other names
Kokomo Gastroenterology & Hepatology
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW KELLAR (REGIONAL PRACTICE ADMINISTRATOR)
(765) 457-8381
Entity
Organization
Contact information
Practice address
615 SAINT JOSEPH DR, KOKOMO, IN 46901-1890
(765) 236-0610
Mailing address
615 SAINT JOSEPH DR, KOKOMO, IN 46901-1890
(765) 236-0610
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
0104783A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20031200F
—
IN
Enumeration date
05/28/2006
Last updated
11/16/2007
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