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General NPI Number Information
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NPI Number | 1013130483
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Entity Type | Organization
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Legal Business Name | ST JOHNS CLINIC INC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 331 HOSPITAL DR SUITE E
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City | LEBANON
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State | MO
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Zip | 65536-9217
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Country | US
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Telephone | 417-533-6540
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Fax | 417-533-6550
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Provider Business Mailing Address
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Address Line | PO BOX 2580
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City | SPRINGFIELD
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State | MO
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Zip | 65801-2580
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Country | US
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Telephone | 417-829-4620
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Fax | 417-829-4316
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | DONN E. SORENSEN
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Credential |
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Telephone | 417-829-4264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | MO
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