1366511537 NPI number — ST. JOHN'S REGIONAL HEALTH CENTER

Table of content: (NPI 1366511537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366511537 NPI number — ST. JOHN'S REGIONAL HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. JOHN'S REGIONAL HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST. JOHN'S HOME HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366511537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1570 W BATTLEFIELD ST
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65807-4106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-820-7492
Provider Business Mailing Address Fax Number:
417-820-5551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1602 ELLIOTT STREET
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65605-2133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-678-2158
Provider Business Practice Location Address Fax Number:
417-678-0414
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MERRIGAN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL COUNSEL
Authorized Official Telephone Number:
417-820-2258

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  159-22 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 15925HH , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 580701001 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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