NPIMap

Organization Active NPI

St. Joseph Family Medical Clinic, Inc.

  • Specialist
  • Saint Joseph, MO
National Provider Identifier
1700858180
Registry record updated Jun 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
ST. JOSEPH FAMILY MEDICAL CLINIC, INC.
Practice address
2120 S Riverside Rd
Saint Joseph, MO 64507-2535
Phone
(816) 671-1331
Fax
(816) 676-1311
NPI assigned
Feb 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2008

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

Authorized official

Name
Ms. Marilyn Rose Johnson
Title
Business Manager
Phone
(816) 671-1331

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

2120 S Riverside Rd
Saint Joseph, MO 64507-2535

Mailing address

2120 S Riverside Rd
Saint Joseph, MO 64507-2535
Phone (816) 671-1331

Other identifiers 2

IdentifierTypeStateIssuer
503971103MedicaidMO
24542019OtherMOGROUP # FOR BCBS KC

National Provider Directory

National Provider Directory

Locations

2120 S Riverside Rd
Saint Joseph, MO 64507
Phone (816) 671-1331

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1700858180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 S RIVERSIDE RD",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645072535",
            "telephone_number": "816-671-1331",
            "fax_number": "816-676-1311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 S RIVERSIDE RD",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645072535",
            "telephone_number": "816-671-1331",
            "fax_number": "816-676-1311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH FAMILY MEDICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-01",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "816-671-1331",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "503971103",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP # FOR BCBS KC",
            "identifier": "24542019",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; 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.