Organization
ST. JOHN'S PHYSICIANS & CLINICS, INC.
Active
Other names
SJC-Rolla Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
VICKIE JENKINS (PROVIDER ENROLLMENT COORDINATOR)
(417) 829-4264
Entity
Organization
Contact information
Practice address
1605 MARTIN SPRINGS DR, SUITE 210, ROLLA, MO 65401-2931
(573) 458-6326
(573) 458-6763
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
MO
Other
Enumeration date
06/25/2007
Last updated
06/02/2010
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