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General NPI Number Information
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NPI Number | 1770503187
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Entity Type | Organization
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Legal Business Name | ST JOHNS REGIONAL MEDICAL CENTER
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 2727 MCCLELLAND BLVD DEPARTMENT OF RADIOLOGY
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City | JOPLIN
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State | MO
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Zip | 64804
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Country | US
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Telephone | 417-781-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 3436 SOLUTIONS CTR
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City | CHICAGO
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State | IL
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Zip | 60677-0001
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Country | US
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Telephone | 800-525-7212
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN EXECUTIVE
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Name | CHRISTOPHER S MEOLI
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Credential | DO
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Telephone | 417-659-6626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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