1275546863 NPI number — ST JOHNS HEALTH CARE CORPORATION

Table of content: (NPI 1275546863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275546863 NPI number — ST JOHNS HEALTH CARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST JOHNS HEALTH CARE CORPORATION
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 JOHNS HEALTH CARE CORP
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:
1275546863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 HIGHLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14620-3024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-760-1208
Provider Business Mailing Address Fax Number:
585-760-1543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14620-3024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-760-1208
Provider Business Practice Location Address Fax Number:
585-760-1543
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MUFFORD
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF PHARMAST
Authorized Official Telephone Number:
585-760-1439

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  022945 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02212224 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3321320 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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