Organization
ST JOHNS EXPRESS CARE
Active
Parent organization
ST JOHNS MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST JOHNS MEDICAL GROUP
Authorized official
PAUL EBMEIER (CEO)
(417) 625-2878
Entity
Organization
Contact information
Practice address
1313 S RANGELINE RD, JOPLIN, MO 64801-5588
(417) 625-2878
(417) 625-2807
Mailing address
PO BOX 1240, JOPLIN, MO 64802-1240
(417) 625-2878
(417) 625-2807
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5115270002
DMERC
MO
Enumeration date
05/28/2006
Last updated
08/25/2008
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