Healthcare Provider Details

I. General information

NPI: 1518150150
Provider Name (Legal Business Name): ST JOHN'S REGIONAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 W MOUNT VERNON ST SUITE 130
NIXA MO
65714-9609
US

IV. Provider business mailing address

940 W MOUNT VERNON ST SUITE 130
NIXA MO
65714-9609
US

V. Phone/Fax

Practice location:
  • Phone: 417-724-5350
  • Fax: 417-724-5354
Mailing address:
  • Phone: 417-724-5350
  • Fax: 417-724-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2005012026
License Number StateMO

VIII. Authorized Official

Name: MR. JAY GUFFEY
Title or Position: COO
Credential:
Phone: 417-820-2520