ST JOHNS CLINIC INC NPI 1740316728

NPI Information

NPI: 1740316728
Provider Name: ST JOHNS CLINIC INC

Doing Business As: SJC-CASSVILLE

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
90 GRAVEL ST
CASSVILLE, MO
ZIP 65625
Phone: (417) 847-6045
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ST JOHNS CLINIC INC is a rural health clinic center in Cassville, MO. ST JOHNS CLINIC INC NPI is 1740316728. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Sjc-cassville.

The provider's business location address is:

90 GRAVEL ST
CASSVILLE, MO
ZIP 65625-601
Phone: (417) 847-6045
Fax: (417) 847-6049

The provider's authorized official is Donn E. Sorensen .
The authorized official title is Chief Operating Officer and has the following contact phone number (417) 829-4264.

The enumeration date for this NPI number is 2/26/2007 and was last updated on 6/30/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		R4E21	MISSOURI	No
2	363A00000X	Physician Assistant		104182	MISSOURI	No
3	261QR1300X	Clinic/Center	Rural Health		MISSOURI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	598833101	MEDICAID	MISSOURI
2	268923	MEDICARE OSCAR/CERTIFICATION	MISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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