# ST. JOHN'S CLINIC, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003187402
- **Authorized official:** DONN E. SORENSEN (VICE PRESIDENT AMBULATORY CARE)
- **Authorized official phone:** (417) 820-6556

## Contact information

- **Practice address:** 940 W MOUNT VERNON ST, NIXA, MO 65714-9609
- **Practice address phone:** (417) 724-5437
- **Practice address fax:** (417) 724-5433
- **Mailing address:** PO BOX 2580, SPRINGFIELD, MO 65801-2580
- **Mailing address phone:** (417) 829-4620
- **Mailing address fax:** (417) 829-4316

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | MO | Yes |

## Other

- **Enumeration date:** 01/18/2012
- **Last updated:** 01/18/2012