St. Joseph Primary LLC
Organization Active NPI Ambulatory Surgical Clinic/Center · Kokomo, IN
NPI 1295935484 · NPPES record last updated Nov 16, 2007
Key facts
- NPI
- 1295935484
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulatory Surgical Clinic/Center 261QA1903X
- Legal business name
- ST. JOSEPH PRIMARY LLC
- Practice address
- 2343 W Lincoln Rd
Kokomo, IN 46902-8012 - Phone
- (765) 455-4090
- Fax
- (765) 457-4443
- NPI assigned
- Jul 25, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Andrew Kellar
- Title
- Regional Practice Administrator
- Phone
- (765) 457-8381
Other NPIs on the same Medicare enrollment 1
Practitioners 15
-
Lesley N Adibe, MD
-
Claude Merrill Ashby, M.D.
-
Alexander S Choi, MD
-
Melissa Anne Cogdell, CRNA
-
Linda J Zynger, MD
-
Jonathan Abraham Holmer, CRNA, MSN, RN
-
Danny L. Resser, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040901000956 | IN | Part B Supplier - Clinic/Group Practice | 5294700274 |
Receives reassigned benefits from 19 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Kokomo, IN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | Yes |
Addresses
Primary practice location
2343 W Lincoln Rd
Kokomo, IN 46902-8012
Mailing address
2343 W Lincoln Rd
Kokomo, IN 46902-8012
Phone (765) 455-4090
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000183506 | Other | IN | BCBS |
Other names
- Lincoln Rd. Surgeons
Other providers in Kokomo, IN
- St. Joseph Primary Care LLC
- St. Joseph Primary Care LLC
- St. Joseph Primary Care, LLC
- St. Joseph Primary Care, LLC
- St. Joseph Primary Care, LLC
- St. Vincent Anderson Regional Hospital, Inc.
- St. Vincent Health Wellness and Preventive Care Institute, Inc.
- St. Vincent Health Wellness and Preventive Care Institute, Inc.
- St. Vincent Hospice - Anderson LLC
- St. Vincent Medical Group, Inc.
All providers in Kokomo, IN · Ambulatory Surgical Clinic/Center in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.