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General NPI Number Information
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NPI Number | 1518150150
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Entity Type | Organization
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Legal Business Name | ST JOHN'S REGIONAL HEALTH CENTER
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Dates
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Enumeration Date | 08/27/2007
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 940 W MOUNT VERNON ST SUITE 130
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City | NIXA
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State | MO
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Zip | 65714-9609
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Country | US
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Telephone | 417-724-5350
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Fax | 417-724-5354
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Provider Business Mailing Address
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Address Line | 940 W MOUNT VERNON ST SUITE 130
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City | NIXA
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State | MO
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Zip | 65714-9609
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Country | US
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Telephone | 417-724-5350
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Fax | 417-724-5354
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Authorized Official
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Title or Position | COO
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Name | MR. JAY GUFFEY
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Credential |
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Telephone | 417-820-2520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2005012026
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License Number State | MO
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