| Integumed LLC | |
|
194 E Southway Blvd Kokomo IN 46902-3650 | |
| (765) 485-1814 | |
| (765) 316-7962 |
| Full Name | Integumed LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 194 E Southway Blvd, Kokomo, Indiana |
| Authorized Official Name and Position | Kellee E Perry (OWNER) |
| Authorized Official Contact | 7652513987 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integumed LLC 12315 Hancock St Ste 24 Carmel IN 46032-5885 Ph: (317) 708-3732 | Integumed LLC 194 E Southway Blvd Kokomo IN 46902-3650 Ph: (765) 485-1814 |
| NPI Number | 1306569546 |
|---|---|
| Provider Enumeration Date | 09/22/2022 |
| Last Update Date | 09/24/2025 |
| Certification Date | 09/24/2025 |
| Medicare PECOS PAC ID | 6103202593 |
|---|---|
| Medicare Enrollment ID | O20221010000376 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306569546 | NPI | - | NPPES |
| 300076258 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 363L00000X | Nurse Practitioner | () | Secondary |
| Provider Name | Miranda Tedder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023650868 PECOS PAC ID: 1658603287 Enrollment ID: I20191030002906 |
| Provider Name | Kellee Perry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154073963 PECOS PAC ID: 1850770249 Enrollment ID: I20220615000346 |
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