Organization Name: | ST. JOHN'S MEDICAL GROUP |
NPI Number: | 1376579565 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAUL EBMEIER (COO) |
Mailing Address: | 307 N Hospital Dr Suite 5 Girard |
State: | KS US |
Postal Code: | 667432014 |
Phone Number: | 6207244659 |
Fax Number: | 6207246955 |
NPI Enumeration Date: | 06/23/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |