1285844688 NPI number — MERCY ST JOHN'S

Table of content: ANGELICA MARMANILLO RN, BSN (NPI 1871945998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285844688 NPI number — MERCY ST JOHN'S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY ST JOHN'S
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 THERAPY SERVICES
Provider Other Organization Name Type Code:
5
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:
1285844688
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:
247 EMERALD LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARSHFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65706-9010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-859-4173
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
331 HOSPITAL DR STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65536-9251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-533-6315
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
417-533-6315

Provider Taxonomy Codes

  • Taxonomy code: 282NR1301X , with the licence number:  107422 , 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)





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