Provider Demographics
NPI:1063725158
Name:ST. JOE HEALTH CARE AND WELLNESS, LLC
Entity type:Organization
Organization Name:ST. JOE HEALTH CARE AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-676-1700
Mailing Address - Street 1:3725 GENE FIELD RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1878
Mailing Address - Country:US
Mailing Address - Phone:816-676-1700
Mailing Address - Fax:816-676-1737
Practice Address - Street 1:3725 GENE FIELD RD STE A
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-1878
Practice Address - Country:US
Practice Address - Phone:816-676-1700
Practice Address - Fax:816-676-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9G93207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202823811Medicaid
1558320531OtherPHYSICIAN NPI
MO202823811Medicaid
1558320531OtherPHYSICIAN NPI