| Integumed Llc | |
|
1958 W Boulevard Kokomo IN 46902-6078 | |
| (765) 485-1814 | |
| Not Available |
| Full Name | Integumed Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1958 W Boulevard, Kokomo, Indiana |
| Authorized Official Name and Position | Kellee E Perry (OWNER) |
| Authorized Official Contact | 7652513987 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integumed Llc 606 E Grant St Marion IN 46952-2950 Ph: (765) 251-3987 | Integumed Llc 1958 W Boulevard Kokomo IN 46902-6078 Ph: (765) 485-1814 |
| NPI Number | 1306569546 |
|---|---|
| Provider Enumeration Date | 09/22/2022 |
| Last Update Date | 05/17/2023 |
| Medicare PECOS PAC ID | 6103202593 |
|---|---|
| Medicare Enrollment ID | O20221010000376 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306569546 | NPI | - | NPPES |
| 300072138 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Kellee Perry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154073963 PECOS PAC ID: 1850770249 Enrollment ID: I20220615000346 |
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