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General NPI Number Information
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NPI Number | 1144306382
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Entity Type | Organization
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Legal Business Name | ST JOHN MEDICAL CENTER INC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 1923 S UTICA AVE
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City | TULSA
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State | OK
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Zip | 74104-6520
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Country | US
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Telephone | 918-744-2345
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Fax |
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Provider Business Mailing Address
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Address Line | 1923 S UTICA AVE
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City | TULSA
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State | OK
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Zip | 74104-6520
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Country | US
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Telephone | 918-744-2345
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CHIEF EXECUTIVE OFFICER
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Name | SR. M. THERESE GOTTSCHALK
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Credential |
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Telephone | 918-744-2180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 2265
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License Number State | OK
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