Healthcare Provider Details

I. General information

NPI: 1770503187
Provider Name (Legal Business Name): ST JOHNS REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 MCCLELLAND BLVD DEPARTMENT OF RADIOLOGY
JOPLIN MO
64804
US

IV. Provider business mailing address

3436 SOLUTIONS CTR
CHICAGO IL
60677-0001
US

V. Phone/Fax

Practice location:
  • Phone: 417-781-2727
  • Fax:
Mailing address:
  • Phone: 800-525-7212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER S MEOLI
Title or Position: PHYSICIAN EXECUTIVE
Credential: DO
Phone: 417-659-6626