Healthcare Provider Details

I. General information

NPI: 1366511537
Provider Name (Legal Business Name): ST. JOHN'S REGIONAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 ELLIOTT STREET SUITE E
AURORA MO
65605-2133
US

IV. Provider business mailing address

1570 W BATTLEFIELD ST SUITE 110
SPRINGFIELD MO
65807-4106
US

V. Phone/Fax

Practice location:
  • Phone: 417-678-2158
  • Fax: 417-678-0414
Mailing address:
  • Phone: 417-820-7492
  • Fax: 417-820-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number159-22
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number15925HH
License Number StateMO

VIII. Authorized Official

Name: MICHAEL MERRIGAN
Title or Position: GENERAL COUNSEL
Credential:
Phone: 417-820-2258