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)
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
231H00000X
Audiologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000260001001
BLUE CROSS OF OKLAHOMA
OK
01
—
007750
FAMILY HEALTH PARTNERS
KS
01
—
100000880C
KANSAS MEDICAID
—
01
—
100693700B
OKLAHOMA MEDICAID
—
01
—
101PD001
MO BLUE CROSS
MO
01
—
200900
BLACK LUNG
MD
01
—
440548809
RAILROAD MEDICARE
MO
05
—
540564507
—
MO
Enumeration date
10/05/2006
Last updated
06/16/2009
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