NPIMap

Organization Active NPI

St. John's Clinic, Inc.

  • Rural Health Clinic/Center
  • Nixa, MO
National Provider Identifier
1003187402
Registry record updated Jan 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ST. JOHN'S CLINIC, INC.
Practice address
940 W Mount Vernon St
Nixa, MO 65714-9609
Phone
(417) 724-5437
Fax
(417) 724-5433
NPI assigned
Jan 18, 2012
Last updated
Jan 18, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donn E. Sorensen
Title
Vice President Ambulatory Care
Phone
(417) 820-6556

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X MO Primary

Addresses

Primary practice location

940 W Mount Vernon St
Nixa, MO 65714-9609

Mailing address

PO Box 2580
Springfield, MO 65801-2580
Phone (417) 829-4620

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGOtherMORURAL HEALTH MEDICARE

National Provider Directory

National Provider Directory
Tax ID family
Springfield Clinic Nucl55 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

940 W Mount Vernon St
Ste 100
Nixa, MO 65714
Phone (417) 724-5200

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326844800000",
    "number": "1003187402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2580",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658012580",
            "telephone_number": "417-829-4620",
            "fax_number": "417-829-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 W MOUNT VERNON ST",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "657149609",
            "telephone_number": "417-724-5437",
            "fax_number": "417-724-5433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN'S CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-18",
        "last_updated": "2012-01-18",
        "status": "A",
        "authorized_official_last_name": "SORENSEN",
        "authorized_official_first_name": "DONN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "VICE PRESIDENT AMBULATORY CARE",
        "authorized_official_telephone_number": "417-820-6556"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RURAL HEALTH MEDICARE",
            "identifier": "PENDING",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nixa, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.