Organization
ST JOHNS CLINIC INC
Active
Other names
SJC-Women's Oncology
Organization subpart
No
Provider details
NPI number
Authorized official
DONN E. SORENSEN (PROVIDER ENROLLMENT COORDINATOR)
(417) 829-4264
Entity
Organization
Contact information
Practice address
2055 S. FREMONT, SUITE 200, SPRINGFIELD, MO 65804
(417) 820-3554
(417) 820-3587
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
MO
Other
Enumeration date
06/27/2007
Last updated
06/30/2008
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