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General NPI Number Information
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NPI Number | 1811084635
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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 | 10/05/2006
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 2931 MCCLELLAND BLVD
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City | JOPLIN
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State | MO
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Zip | 64804-1633
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Country | US
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Telephone | 417-781-2727
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Fax | 417-625-2910
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Provider Business Mailing Address
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Address Line | 2727 MCCLELLAND BLVD
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City | JOPLIN
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State | MO
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Zip | 64804-1695
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Country | US
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Telephone | 417-781-2727
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Fax | 417-625-2910
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Authorized Official
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Title or Position | CEO PRESIDENT
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Name | MR. GARY PULSIPHER
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Credential |
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Telephone | 417-781-2727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | 11840
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License Number State | MO
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