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Organization
ST JOHNS REGIONAL MEDICAL CENTER
Active
Organization
ST JOHNS REGIONAL MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALTER C DANDRIDGE JR. MD (INTERIM CHIEF MEDICAL OFFICER)
(417) 625-2232
Entity
Organization
Contact information
Practice address
2727 MCCLELLAND BLVD, JOPLIN, MO 64804-1695
(417) 781-2727
(417) 625-2910
Mailing address
PO BOX 1240, JOPLIN, MO 64802-1240
(417) 627-8930
(417) 627-8920
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
NULL
207RC0000X
Cardiovascular Disease Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
NULL
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
231H00000X
Audiologist
—
NULL
231H00000X
Audiologist
—
—
Other
Enumeration date
10/05/2006
Last updated
06/16/2009
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