Provider Demographics
NPI:1487610143
Name:ST JOHNS OF AURORA HOSPITAL
Entity type:Organization
Organization Name:ST JOHNS OF AURORA HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-678-2122
Mailing Address - Street 1:3952 S FAIRVIEW AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4604
Mailing Address - Country:US
Mailing Address - Phone:417-887-5568
Mailing Address - Fax:417-883-5514
Practice Address - Street 1:500 PORTER AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-2365
Practice Address - Country:US
Practice Address - Phone:417-678-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO059261207L00000X
MO141567207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR00164Medicare UPIN
MO1060240Medicare ID - Type Unspecified
MO0060240Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MOR83474Medicare UPIN
MO3060240Medicare ID - Type Unspecified