1194826453 NPI number — ST JOHNS REGIONAL MEDICAL CENTER

Table of content: (NPI 1194826453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194826453 NPI number — ST JOHNS REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST JOHNS REGIONAL MEDICAL 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:
Provider Other Organization Name Type Code:
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:
1194826453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2727 MCCLELLAND BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64804-1695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-781-2727
Provider Business Mailing Address Fax Number:
417-625-2910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2727 MCCLELLAND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-1695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-781-2727
Provider Business Practice Location Address Fax Number:
417-625-2910
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PULSIPHER
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
417-781-2727

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  11848 , 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: 00026001001 . This is a "BLUE CROSS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100000880A . This is a "MEDICAID" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: XHSP31171 . This is a "MEDICAID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0004877 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 007311 . This is a "MEDICAID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 010564508 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100693700A . This is a "MEDICAID" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 80053 . This is a "BLUE CROSS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: XHSP41171 . This is a "MEDICAID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HS90PMO . This is a "MEDICAID" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: HS91PMO . This is a "MEDCAID" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 000959274X . This is a "MEDICAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 0935510 . This is a "MEDICAID" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 95885019 . This is a "BLUE CROSS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 107954105 . This is a "MEDICAID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 159 . This is a "BLUE CROSS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 95017745 . This is a "MEDICAID" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 909599300 . This is a "MEDICAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: STJ0001N . This is a "MEDICAID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com