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General NPI Number Information
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NPI Number | 1417904152
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Entity Type | Organization
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Legal Business Name | ST JOSEPH PRIMARY CARE PHYSICIANS, LLC
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1692 W LOGANSPORT RD
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City | PERU
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State | IN
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Zip | 46970-3149
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Country | US
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Telephone | 765-472-4460
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Fax | 765-472-4548
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Provider Business Mailing Address
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Address Line | 1692 W LOGANSPORT RD
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City | PERU
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State | IN
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Zip | 46970-3149
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Country | US
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Telephone | 765-472-4460
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Fax | 765-472-4548
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Authorized Official
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Title or Position | PHYSICIAN
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Name | GREGORY A QUIN
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Credential | MD
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Telephone | 765-472-4460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01045818A
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License Number State | IN
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