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Organization

ST. JOSEPH FAMILY MEDICAL CLINIC, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. MARILYN ROSE JOHNSON (BUSINESS MANAGER)
(816) 671-1331
Entity
Organization

Contact information

Practice address
2120 S RIVERSIDE RD, SAINT JOSEPH, MO 64507-2535
(816) 671-1331
(816) 676-1311
Mailing address
2120 S RIVERSIDE RD, SAINT JOSEPH, MO 64507-2535
(816) 671-1331
(816) 676-1311

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
24542019
GROUP # FOR BCBS KC
MO
05
503971103
MO
Enumeration date
02/01/2006
Last updated
06/27/2008
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