| St Joseph Primary Llc | |
|
5111 Clinton Dr Kokomo IN 46902-7136 | |
| (765) 453-8800 | |
| (765) 457-4443 |
| Full Name | St Joseph Primary Llc |
|---|---|
| Speciality | Clinic/center - Urgent Care |
| Location | 5111 Clinton Dr, Kokomo, Indiana |
| Authorized Official Name and Position | Andrew Kellar (REGIONAL PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 7654578381 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St Joseph Primary Llc 5111 Clinton Dr Kokomo IN 46902-7136 Ph: (765) 453-8800 | St Joseph Primary Llc 5111 Clinton Dr Kokomo IN 46902-7136 Ph: (765) 453-8800 |
| NPI Number | 1073569364 |
|---|---|
| Provider Enumeration Date | 05/26/2006 |
| Last Update Date | 11/16/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073569364 | NPI | - | NPPES |
| 20031200 | Medicaid | IN | |
| 000000183506 | Other | IN | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Indiana) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (Indiana) | Primary |
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