Organization
ST JOHNS REGIONAL MEDICAL CENTER
Active
Other names
21st Century Anesthesia
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE CARALIS (CEO)
(417) 781-2727
Entity
Organization
Contact information
Practice address
2727 MCCLELLAND BLVD, JOPLIN, MO 64804-1626
(417) 781-2727
Mailing address
PO BOX 760, JOPLIN, MO 64802-0760
(417) 624-3040
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LA0401X
Addiction Medicine (Anesthesiology) Physician
—
—
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000880E
—
KS
05
—
100693700M
—
OK
01
—
108602A
BCBS
MO
05
—
505098509
—
MO
01
—
CG9560
RAILROAD MEDICARE
—
Enumeration date
05/11/2006
Last updated
06/22/2009
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