Organization Name: | ST. JOHN'S CLINIC, INC. |
NPI Number: | 1003187402 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DONN E. SORENSEN (VICE PRESIDENT AMBULATORY CARE) |
Mailing Address: | 940 W Mount Vernon St Nixa |
State: | MO US |
Postal Code: | 657149609 |
Phone Number: | 4177245437 |
Fax Number: | 4177245433 |
NPI Enumeration Date: | 01/18/2012 |
NPI Last Update Date: | 01/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |