Organization
ST JOHNS REGIONAL MEDICAL CENTER
Active
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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