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General NPI Number Information
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NPI Number | 1104032721
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Entity Type | Organization
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Legal Business Name | ST JOHN'S HOSPITAL LEBANON
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 331 HOSPITAL DR
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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 | 417-533-6315
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Fax |
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Provider Business Mailing Address
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Address Line | 2444 COPPERWOOD DR
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City | LEBANON
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State | MO
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Zip | 65536-5964
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Country | US
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Telephone | 471-594-0217
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF REHAB SERVICES
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Name | TERRI FOSTER
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Credential | PT
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Telephone | 417-533-6315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | 2001030555
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License Number State | MO
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