Organization
ST. JOHN'S CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONN E. SORENSEN (VICE PRESIDENT AMBULATORY CARE)
(417) 820-6556
Entity
Organization
Contact information
Practice address
940 W MOUNT VERNON ST, NIXA, MO 65714-9609
(417) 724-5437
(417) 724-5433
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
RURAL HEALTH MEDICARE
MO
Enumeration date
01/18/2012
Last updated
01/18/2012
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