Organization
ST. JOSEPH FAMILY MEDICAL CLINIC, INC.
Active
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
Update your record
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