Basic Information
| Provider Information | |||||||||
| NPI: | 1194826453 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST JOHNS REGIONAL MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2727 MCCLELLAND BLVD | ||||||||
| Address2: | |||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648041695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4177812727 | ||||||||
| FaxNumber: | 4176252910 | ||||||||
| Practice Location | |||||||||
| Address1: | 2727 MCCLELLAND BLVD | ||||||||
| Address2: | |||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648041695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4177812727 | ||||||||
| FaxNumber: | 4176252910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 11/25/2009 | ||||||||
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| AuthorizedOfficialLastName: | PULSIPHER | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 4177812727 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CATHOLIC HEALTH INITIATIVES | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 11848 | MO | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 00026001001 | 01 | OK | BLUE CROSS | OTHER | 100000880A | 01 | KS | MEDICAID | OTHER | XHSP31171 | 01 | CA | MEDICAID | OTHER | 0004877 | 01 | TN | BLUE CROSS | OTHER | 007311 | 01 | AZ | MEDICAID | OTHER | 010564508 | 05 | MO | MEDICAID | 100693700A | 01 | OK | MEDICAID | OTHER | 80053 | 01 | KS | BLUE CROSS | OTHER | XHSP41171 | 01 | CA | MEDICAID | OTHER | HS90PMO | 01 | AK | MEDICAID | OTHER | HS91PMO | 01 | AK | MEDCAID | OTHER | 000959274X | 01 | GA | MEDICAID | OTHER | 0935510 | 01 | IA | MEDICAID | OTHER | 95885019 | 01 | MO | BLUE CROSS | OTHER | 107954105 | 01 | AR | MEDICAID | OTHER | 159 | 01 | MO | BLUE CROSS | OTHER | 95017745 | 01 | CO | MEDICAID | OTHER | 909599300 | 01 | FL | MEDICAID | OTHER | STJ0001N | 01 | AL | MEDICAID | OTHER |