| Organization Name: | ST JOHNS CLINIC INC |
| NPI Number: | 1013130483 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DONN E. SORENSEN (SENIOR VICE PRESIDENT) |
| Mailing Address: | 331 Hospital Dr Suite E Lebanon |
| State: | MO US |
| Postal Code: | 655369217 |
| Phone Number: | 4175336540 |
| Fax Number: | 4175336550 |
| NPI Enumeration Date: | 04/11/2007 |
| NPI Last Update Date: | 09/27/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |