Organization
ST JOHNS CLINIC INC
Active
Other names
SJC Women's Health Huntsville
Organization subpart
No
Provider details
NPI number
Authorized official
DONN E. SORENSEN (SENIOR VICE PRESIDENT)
(417) 829-4264
Entity
Organization
Contact information
Practice address
705 PHILLIPS, HUNTSVILLE, AR 72740
(479) 738-1700
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
E4990
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166387002
—
AR
01
—
5F873
AR BLUE SHIELD
AR
Enumeration date
07/20/2007
Last updated
06/30/2008
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