Healthcare Provider Details

I. General information

NPI: 1710923636
Provider Name (Legal Business Name): ST. JOHN'S MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 BARKER DR
OSWEGO KS
67356-9034
US

IV. Provider business mailing address

1701 W 26TH ST SUITE B
JOPLIN MO
64804-1513
US

V. Phone/Fax

Practice location:
  • Phone: 620-795-2525
  • Fax: 620-795-4666
Mailing address:
  • Phone: 417-267-8967
  • Fax: 417-627-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBIN SUMNER
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 417-627-8930