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General NPI Number Information
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NPI Number | 1528564929
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Entity Type | Organization
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Legal Business Name | ST. JOHN PHYSICIANS, INC.
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 1717B S UTICA AVE STE 205
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City | TULSA
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State | OK
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Zip | 74104-5332
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Country | US
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Telephone | 918-744-2444
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Fax | 918-744-2483
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Provider Business Mailing Address
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Address Line | 1923 S UTICA AVE # DT1000
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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 | 918-744-2630
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Fax | 918-744-2946
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Authorized Official
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Title or Position | DIRECTOR CHIEF FINANCIAL OFFICER
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Name | JAMES BRYAN FISSEL
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Credential |
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Telephone | 918-748-7617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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