St Joseph Primary LLC
Organization Active NPI Pediatrics Physician · Kokomo, IN
NPI 1982650164 · NPPES record last updated Nov 16, 2007
Key facts
- NPI
- 1982650164
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- ST JOSEPH PRIMARY LLC
- Practice address
- 3109 W Sycamore St
Kokomo, IN 46901-4026 - Phone
- (765) 457-8381
- Fax
- (765) 457-4443
- NPI assigned
- May 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Andrew Kellar
- Title
- Regional Practice Administrator
- Phone
- (765) 457-8381
Corporate family (same tax ID) 12
National Provider Directory
- Tax ID family
- St Joseph Primary LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | IN | Yes |
Addresses
Primary practice location
3109 W Sycamore St
Kokomo, IN 46901-4026
Mailing address
3109 W Sycamore St
Kokomo, IN 46901-4026
Phone (765) 457-8381
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000183506 | Other | IN | BLUE CROSS BLUE SHIELD |
Other names
- Sycamore Pediatrics & Adolescents
Other providers in Kokomo, IN
- Indiya St Clair
- St Joseph Primary LLC
- St Joseph Primary LLC
- St Joseph Primary LLC
- St Joseph Primary LLC
- St. Joseph Hospital & Health Center, Inc.
- St. Joseph Hospital & Health Center, Inc.
- St. Joseph Hospital & Health Center, Inc.
- St. Joseph Hospital & Health Center, Inc.
- St. Joseph Hospital & Health Center, Inc.
All providers in Kokomo, IN · Pediatrics Physician 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.