Healthcare Provider Details

I. General information

NPI: 1639187404
Provider Name (Legal Business Name): SAINT JOHN HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 S 4TH ST
LEAVENWORTH KS
66048-5043
US

IV. Provider business mailing address

3500 S 4TH ST
LEAVENWORTH KS
66048-5043
US

V. Phone/Fax

Practice location:
  • Phone: 913-680-6000
  • Fax:
Mailing address:
  • Phone: 913-680-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberH052002
License Number StateKS

VIII. Authorized Official

Name: MR. GREG MADSEN IX
Title or Position: VP, ADMINISTRATOR
Credential:
Phone: 913-680-6014