Provider Demographics
NPI:1366511537
Name:ST. JOHN'S REGIONAL HEALTH CENTER
Entity type:Organization
Organization Name:ST. JOHN'S REGIONAL HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-820-2258
Mailing Address - Street 1:1570 W BATTLEFIELD ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4106
Mailing Address - Country:US
Mailing Address - Phone:417-820-7492
Mailing Address - Fax:417-820-5551
Practice Address - Street 1:1602 ELLIOTT STREET
Practice Address - Street 2:SUITE E
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-2133
Practice Address - Country:US
Practice Address - Phone:417-678-2158
Practice Address - Fax:417-678-0414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO159-22251E00000X
MO15925HH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO580701001Medicaid
MO580701001Medicaid