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General NPI Number Information
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NPI Number | 1700821899
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Entity Type | Organization
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Legal Business Name | ST. JOHN'S MEDICAL GROUP
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 09/02/2009
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Provider Practice Location Address
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Address Line | 101 W SYCAMORE ST
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City | COLUMBUS
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State | KS
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Zip | 66725-1276
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Country | US
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Telephone | 620-429-3636
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Fax | 620-429-1301
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Provider Business Mailing Address
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Address Line | 1701 W 26TH ST SUITE B
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City | JOPLIN
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State | MO
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Zip | 64804-1513
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Country | US
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Telephone | 417-627-8967
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Fax | 417-627-8920
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Authorized Official
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Title or Position | REVENUE CYCLE DIRECTOR
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Name | MRS. ROBIN SUMNER
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Credential |
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Telephone | 417-627-8930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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