Organization
ST. JOSEPH PRIMARY CARE, LLC
Active
Other names
Sycamore Pediatrics and Adolescents
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES E. WHITFIELD MD (MEDICAL DIRECTOR)
(765) 457-8381
Entity
Organization
Contact information
Practice address
712 W MAIN ST, GREENTOWN, IN 46936-1045
(765) 628-3317
(765) 628-5979
Mailing address
712 W MAIN ST, GREENTOWN, IN 46936-1045
(765) 628-3317
(765) 628-5979
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01060986A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000378656
BLUE CROSS BLUE SHIELD
IN
01
—
1285615336
NPI
IN
Enumeration date
06/07/2007
Last updated
08/22/2020
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