Provider Demographics
NPI:1144264870
Name:ST. JOHN'S PHYSICIANS & CLINICS, INC.
Entity type:Organization
Organization Name:ST. JOHN'S PHYSICIANS & CLINICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-820-6556
Mailing Address - Street 1:ST. JOHN'S PHYSICIANS & CLINICS, INC.
Mailing Address - Street 2:1965 S. FREMONT
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804
Mailing Address - Country:US
Mailing Address - Phone:417-829-4264
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:ST. JOHN'S PHYSICIANS & CLINICS, INC.
Practice Address - Street 2:620 S. GLENSTONE
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802
Practice Address - Country:US
Practice Address - Phone:417-829-4620
Practice Address - Fax:417-829-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3B791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty