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Organization
ST JOHNS CLINIC INC
Active
Organization
ST JOHNS CLINIC INC
Active
Other names
SJC Women's Health Huntsville
Organization subpart
No
Provider details
NPI number
Authorized official
DONN E. SORENSEN (SENIOR VICE PRESIDENT)
(417) 829-4264
Entity
Organization
Contact information
Practice address
705 PHILLIPS, HUNTSVILLE, AR 72740
(479) 738-1700
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
E4990
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166387002
—
AR
01
—
5F873
AR BLUE SHIELD
AR
Enumeration date
07/20/2007
Last updated
06/30/2008
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