Organization
ST JOHN MEDICAL CENTER INC
Active
Other names
Bernsen Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
SR. M. THERESE GOTTSCHALK (PRESIDENT/CHIEF EXECUTIVE OFFICER)
(918) 744-2180
Entity
Organization
Contact information
Practice address
1923 S UTICA AVE, TULSA, OK 74104-6520
(918) 744-2345
Mailing address
1923 S UTICA AVE, TULSA, OK 74104-6520
(918) 744-2345
Taxonomy
Speciality
Code
Description
License number
State
273Y00000X
Rehabilitation Hospital Unit
Primary
2265
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000370114001
BCBS OF OK
OK
05
—
100699400A
—
OK
01
—
74104 0000
CHAMPUS
OK
Enumeration date
10/02/2006
Last updated
11/10/2010
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