Organization
ST. JOHN'S CLINIC, INC.
Active
Other names
William K. Flake, MD
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONN E. SORENSEN (SENIOR VICE PRESIDENT/COO)
(417) 820-6556
Entity
Organization
Contact information
Practice address
203 RICE ST, BERRYVILLE, AR 72616-4388
(870) 423-3338
(870) 423-7330
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
R2975
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130968002
—
AR
Enumeration date
07/05/2006
Last updated
07/11/2008
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