Organization
ST. JOSEPH PRIMARY LLC
Active
Other names
Lincoln Rd. Surgeons
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW KELLAR (REGIONAL PRACTICE ADMINISTRATOR)
(765) 457-8381
Entity
Organization
Contact information
Practice address
2343 W LINCOLN RD, KOKOMO, IN 46902-8012
(765) 455-4090
(765) 457-4443
Mailing address
2343 W LINCOLN RD, KOKOMO, IN 46902-8012
(765) 455-4090
(765) 457-4443
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000183506
BCBS
IN
Enumeration date
07/25/2007
Last updated
11/16/2007
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