DataLabs

datalabs.health made in the usa

Contact us Sign in | Documentation |

divider

Medicare/Medicaid Verification Programs divider

divider

Medicare Verification Program divider

divider

1811952070

NPI Code Detail

MEDICARE: ST JOSEPH MEDICAL GROUP INC

MEDICARE: ST JOSEPH MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician
2	207R00000X	Internal Medicine Physician
3	207Q00000X	Family Medicine Physician
4	207RG0300X	Geriatric Medicine (Internal Medicine) Physician
5	2084P0800X	Psychiatry Physician
6	207K00000X	Allergy & Immunology Physician
7	208000000X	Pediatrics Physician
8	207RH0003X	Hematology & Oncology Physician
9	363L00000X	Nurse Practitioner
10	363A00000X	Physician Assistant
11	104100000X	Social Worker
12	207RP1001X	Pulmonary Disease Physician
13	207X00000X	Orthopaedic Surgery Physician
14	208D00000X	General Practice Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811952070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JOSEPH MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	2622 LAKE AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5410
Country	:	US
Telephone Number	:	260-425-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2622 LAKE AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5410
Country	:	US
Telephone Number	:	260-425-3100
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PHYSICIAN OPERATIONS
Name	:	SOPHIA L ARWOOD
Credential	:
Telephone Number	:	615-628-6038

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	12/15/2015

Similar Medicare Providers

1093718249 — CHUNG SENG LEE M.D.
Practice Location Address:

2622 LAKE AVE
FORT WAYNE, IN
46805-5410

Practice Phone: 260-425-3100
Practice Fax: 260-425-3604

1255322103 — ALLIED PHYSICIANS INC., D/B/A FORT WAYNE NEUROSURGERY
Practice Location Address:

2622 LAKE AVE
FORT WAYNE, IN
46805-5410

Practice Phone: 260-460-3100
Practice Fax:

1275507055 — THOMAS P RYAN DO
Practice Location Address:

2622 LAKE AVE
FORT WAYNE, IN
46805-5410

Practice Phone: 260-425-3100
Practice Fax: 260-425-3604

1366410706 — DONAL P DUNNE MD
Practice Location Address:

2622 LAKE AVE
FORT WAYNE, IN
46805-5410

Practice Phone: 260-425-3100
Practice Fax: 260-425-3604

1922063189 — JOHN ADDO MD
Practice Location Address:

2622 LAKE AVE
FORT WAYNE, IN
46805-5410

Practice Phone: 260-425-3100
Practice Fax: 260-425-3604

1598721128 — HOUDA TRABULSI-YOUNIS MD
Practice Location Address:

2622 LAKE AVE
FORT WAYNE, IN
46805-5410

Practice Phone: 260-425-3752
Practice Fax: 260-745-1321

Directions to “ST JOSEPH MEDICAL GROUP INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.