Healthcare Provider Details

I. General information

NPI: 1104032721
Provider Name (Legal Business Name): ST JOHN'S HOSPITAL LEBANON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 HOSPITAL DR
LEBANON MO
65536-9217
US

IV. Provider business mailing address

2444 COPPERWOOD DR
LEBANON MO
65536-5964
US

V. Phone/Fax

Practice location:
  • Phone: 417-533-6315
  • Fax:
Mailing address:
  • Phone: 471-594-0217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number2001030555
License Number StateMO

VIII. Authorized Official

Name: TERRI FOSTER
Title or Position: DIRECTOR OF REHAB SERVICES
Credential: PT
Phone: 417-533-6315