Organization
ST JOSEPH PRIMARY LLC
Active
Other names
St Joseph Physicians Southway
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW KELLAR (REGIONAL PRACTICE ADMINISTRATOR)
(765) 457-8381
Entity
Organization
Contact information
Practice address
188 E SOUTHWAY BLVD, KOKOMO, IN 46902-3650
(765) 453-9000
(765) 457-4443
Mailing address
188 E SOUTHWAY BLVD, KOKOMO, IN 46902-3650
(765) 453-9000
(765) 457-4443
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000183506
BLUE CROSS BLUE SHIELD
IN
Enumeration date
06/01/2006
Last updated
11/16/2007
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