Provider Demographics
NPI:1174812523
Name:ST JOHN'S REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:ST JOHN'S REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WOUND CARE NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:RN,WCC
Authorized Official - Phone:417-781-2727
Mailing Address - Street 1:2727 MCCLELLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1626
Mailing Address - Country:US
Mailing Address - Phone:417-781-2727
Mailing Address - Fax:417-659-6678
Practice Address - Street 1:2727 MCCLELLAND BLVD
Practice Address - Street 2:WOUND CARE
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1626
Practice Address - Country:US
Practice Address - Phone:417-781-2727
Practice Address - Fax:417-659-6678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO123823282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO123823OtherRN