St Johns Clinic Inc

Key facts

NPI

1740316728

Entity type

Organization (NPI type 2)

Primary specialty

Rural Health Clinic/Center 261QR1300X

Legal business name

ST JOHNS CLINIC INC

Practice address

90 Gravel St
Cassville, MO 65625-1601

Phone

(417) 847-6045

Fax

(417) 847-6049

NPI assigned

Feb 26, 2007

Organization subpart

No

Authorized official

Name

Donn E. Sorensen

Title

Chief Operating Officer

Phone

(417) 829-4264

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Mercy Clinic Springfield Communities Rural Health Clinic/Center · El Dorado Springs, MO · NPI 1851427785
  NPD member Member Of

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

Other names

• SJC-Cassville Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 30, 2008.

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1740316728",
    "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": "90 GRAVEL ST",
            "city": "CASSVILLE",
            "state": "MO",
            "postal_code": "656251601",
            "telephone_number": "417-847-6045",
            "fax_number": "417-847-6049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHNS CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "SORENSEN",
        "authorized_official_first_name": "DONN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "417-829-4264"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R4E21",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "104182",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "598833101",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SJC-Cassville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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All providers in Cassville, MO · Rural Health Clinic/Center in Missouri