ST JOSEPH PRIMARY LLC (NPI# 1780631812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780631812 |
| Entity Type | Organization |
| Organization Name | ST JOSEPH PRIMARY LLC |
| Other Organization Name | SYCAMORE PRIMARY & SPECIALTY CARE |
| Practice Address |
712 W Main St Greentown IN 46936-1045 |
| Practice Telephone | 7656283317 |
| Practice Fax Number | 7654574443 |
| Mailing Telephone | 7656283317 |
| Mailing Fax Number | 7654574443 |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2007-11-16 |
| Authorized Official Name | MR. ANDREW KELLAR (REGIONAL PRACTICE ADMINISTRATOR) |
| Authorized Official Telephone | 7654578381 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 173000000X | Legal Medicine | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | BLUE CROSS BLUE SHIELD | 000000183518 | 01 |
| Other Name | Type Code |
|---|---|
| Sycamore Primary & Specialty Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265489975 | St Joseph Primary LLC | Internal Medicine | 615 Saint Joseph Dr, Kokomo, IN 46901-1890 | 2006-05-28 |
| 1073569364 | St Joseph Primary LLC | Family Medicine | 5111 Clinton Dr, Kokomo, IN 46902-7136 | 2006-05-26 |
| 1104866136 | St Joseph Primary LLC | Family Medicine | 3109 W Sycamore St, Kokomo, IN 46901-4026 | 2006-06-07 |
| 1477590164 | St Joseph Primary LLC | Family Medicine | 188 E Southway Blvd, Kokomo, IN 46902-3650 | 2006-06-01 |
| 1982650164 | St Joseph Primary LLC | Pediatrics | 3109 W Sycamore St, Kokomo, IN 46901-4026 | 2006-05-26 |
| Street Address |
712 W MAIN ST |
| City | GREENTOWN |
| State | IN |
| Zip Code | 46936-1045 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548266307 | Peter Douglas Stephan | Family Medicine | 712 W Main St, Greentown, IN 46936-1045 | 2005-06-24 |
| 1336342286 | St. Joseph Primary Care, LLC | Pediatrics | 712 W Main St, Greentown, IN 46936-1045 | 2007-06-07 |
| 1013998723 | Ken O Ridgeway | Family Medicine | 712 W Main St, Greentown, IN 46936-1045 | 2005-11-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538380381 | Lori Kay Stiner | Pharmacist | 710 W Main, Greentown, IN 46936 | 2007-05-01 |
| 1225179864 | Greentown Volunteer Fire Company | Ambulance | 224 N Meridian St, Greentown, IN 46936 | 2007-02-08 |
| 1912349127 | Brian Christopher Mclellan | Dentist | 520 W Main St, Greentown, IN 46936-1021 | 2013-07-29 |
| 1619991247 | Margaux Fraundorfer | Dentist | 520 W Main St, Greentown, IN 46936-1021 | 2006-07-27 |
| 1730103391 | Ladd Dental of Greentown P.C. | Dentist | 520 W Main St, Greentown, IN 46936-1021 | 2006-07-27 |
| 1720247372 | Judith E Lausch | Registered Nurse | 7 Green Hills Ct, Greentown, IN 46936-1039 | 2008-06-07 |
| 1386836930 | Ronald Joseph Essington | Pharmacist | 710 W Main St, Greentown, IN 46936-1045 | 2007-08-16 |
| 1457573891 | Carrie Summerton | Pharmacist | 710 W Main St, Greentown, IN 46936-1045 | 2007-05-03 |
| 1740272053 | Herbst Apothecary Inc | Pharmacy | 710 W Main St, Greentown, IN 46936-1045 | 2005-08-22 |
| 1023672334 | Haven Homecare LLC | In Home Supportive Care | 381 N 700 E, Greentown, IN 46936-1058 | 2019-04-23 |
| Find all providers in zip 46936 | ||||
| Taxonomy Code | 173000000X |
| Grouping | Other Service Providers |
| Classification | Legal Medicine |
| The specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical examinations at crime scenes, performance of autopsies, giving of expert medical testimony in judicial proceedings, medical treatment of inmates of penal institutions, the practice of trauma medicine in law enforcement settings, and other clinical practice and medical science applications in the fields of law, law enforcement, and corrections. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114228723 | Nwi Patient Care LLC. | Legal Medicine | 544 S Lake St, Gary, IN 46403-2473 | 2010-11-12 |
| 1083806376 | Seymour Gastroenterology Consultants, LLC | Legal Medicine | 225 S Pine St Ste 311, Seymour, IN 47274-2367 | 2007-08-10 |
| 1760688451 | Lorenzo Eli | Legal Medicine | 1000 Van Nuys Road, New Castle, IN 47362 | 2007-06-21 |
| 1194815449 | George Robert Small | Legal Medicine | 284 N Madison Ave, Greenwood, IN 46142-3634 | 2006-10-14 |
| 1245329036 | Stephen L Myers | Legal Medicine | Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN 46285-0001 | 2006-10-12 |
| 1861589855 | Young M Kim | Legal Medicine | 4035 Elm St, East Chicago, IN 46312-3042 | 2006-10-09 |
| 1336152271 | Aesop, Inc. | Legal Medicine | 4084 Pendleton Way, # 264, Indianapolis, IN 46226-5224 | 2006-08-14 |
| 1285663435 | Edward Long Jr Md | Legal Medicine | 24068 Professional Park Dr, Lawrenceburg, IN 47025-7600 | 2006-07-01 |
| 1184699068 | Karl W Siebe | Legal Medicine | 865 Westfield Rd, Noblesville, IN 46062-8901 | 2006-02-22 |
| 1700859089 | Freya G Paje | Legal Medicine | 1011 E National Ave, Brazil, IN 47834-2713 | 2006-02-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.