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General NPI Number Information
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NPI Number | 1144474396
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Entity Type | Organization
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Legal Business Name | ST. JOHN'S HEALTH SYSTEM
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 1630 E BRADFORD PKWY SUITE B
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City | SPRINGFIELD
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State | MO
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Zip | 65804-6513
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Country | US
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Telephone | 417-820-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 1235 E CHEROKEE ST
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2203
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Country | US
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Telephone | 417-820-8620
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. BRADLEY KIM DAY
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Credential |
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Telephone | 417-820-2845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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