Provider Demographics
NPI:1194826453
Name:ST JOHNS REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:ST JOHNS REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PULSIPHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-781-2727
Mailing Address - Street 1:2727 MCCLELLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1695
Mailing Address - Country:US
Mailing Address - Phone:417-781-2727
Mailing Address - Fax:417-625-2910
Practice Address - Street 1:2727 MCCLELLAND BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1695
Practice Address - Country:US
Practice Address - Phone:417-781-2727
Practice Address - Fax:417-625-2910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC HEALTH INITIATIVES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-26
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11848282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK00026001001OtherBLUE CROSS
KS100000880AOtherMEDICAID
CAXHSP31171OtherMEDICAID
TN0004877OtherBLUE CROSS
AZ007311OtherMEDICAID
MO010564508Medicaid
OK100693700AOtherMEDICAID
KS80053OtherBLUE CROSS
CAXHSP41171OtherMEDICAID
AKHS90PMOOtherMEDICAID
AKHS91PMOOtherMEDCAID
GA000959274XOtherMEDICAID
IA0935510OtherMEDICAID
MO95885019OtherBLUE CROSS
AR107954105OtherMEDICAID
MO159OtherBLUE CROSS
CO95017745OtherMEDICAID
FL909599300OtherMEDICAID
ALSTJ0001NOtherMEDICAID
CO95017745OtherMEDICAID