Provider Demographics
NPI:1487760849
Name:SAINT JOHN'S HEALTH SYSTEM
Entity type:Organization
Organization Name:SAINT JOHN'S HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-646-8105
Mailing Address - Street 1:75 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-8960
Mailing Address - Country:US
Mailing Address - Phone:765-778-0913
Mailing Address - Fax:765-778-1374
Practice Address - Street 1:75 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-8960
Practice Address - Country:US
Practice Address - Phone:765-778-0913
Practice Address - Fax:765-778-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty