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NPI Code Detail

MEDICARE: ST. JOHN'S MEDICAL GROUP

MEDICARE: ST. JOHN'S MEDICAL GROUP
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
1261QR1300XRural Health Clinic/Center

General Provider Information

NPI Number : 1700821899
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. JOHN'S MEDICAL GROUP
Provider Business Mailing Address
First Line : 1701 W 26TH ST
Second Line : SUITE B
City : JOPLIN
State : MO
Zip : 64804-1513
Country : US
Telephone Number : 417-627-8967
Fax Number : 417-627-8920
Provider Business Practice Location Address
First Line : 101 W SYCAMORE ST
Second Line :
City : COLUMBUS
State : KS
Zip : 66725-1276
Country : US
Telephone Number : 620-429-3636
Fax Number : 620-429-1301
Authorized Official
Title or Position : REVENUE CYCLE DIRECTOR
Name : MRS. ROBIN SUMNER
Credential :
Telephone Number : 417-627-8930
Provider Enumeration Date : 06/20/2006
Last Update Date : 09/02/2009

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