1841233913 NPI number — ST. JOHN'S INC.

Table of content: (NPI 1841233913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841233913 NPI number — ST. JOHN'S INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. JOHN'S INC.
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 CLINIC
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:
1841233913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 E. 3RD ST
Provider Second Line Business Mailing Address:
P.O. BOX 186
Provider Business Mailing Address City Name:
ALDEN
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67512-0186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-534-3085
Provider Business Mailing Address Fax Number:
620-534-3086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 MARC WAGNER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VICTORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-735-2208
Provider Business Practice Location Address Fax Number:
785-735-2270
Provider Enumeration Date:
06/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BETHE;;
Authorized Official First Name:
BOB
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
620-534-3085

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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