Healthcare Provider Details

I. General information

NPI: 1366486052
Provider Name (Legal Business Name): ST. JOHN'S PHYSICIANS & CLINICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S GLENSTONE AVE ST. JOHN'S PHYSICIANS & CLINICS, INC.
SPRINGFIELD MO
65802-3206
US

IV. Provider business mailing address

1965 S FREMONT AVE ST. JOHN'S PHYSICIANS & CLINICS, INC.
SPRINGFIELD MO
65804-2201
US

V. Phone/Fax

Practice location:
  • Phone: 417-829-4620
  • Fax: 417-829-4316
Mailing address:
  • Phone: 417-829-4264
  • Fax: 417-829-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DONN E. SORENSEN
Title or Position: SENIOR VICE PRESIDENT/COO
Credential:
Phone: 417-820-6556