Provider Demographics
NPI:1033176367
Name:ST. JOHN PHYSICIANS, INC
Entity Type:Organization
Organization Name:ST. JOHN PHYSICIANS, INC
Other - Org Name:SIGGINS MEMORIAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-331-1090
Mailing Address - Street 1:112 N 5TH
Mailing Address - Street 2:P.O. BOX 609
Mailing Address - City:BARNSDALL
Mailing Address - State:OK
Mailing Address - Zip Code:74002-0609
Mailing Address - Country:US
Mailing Address - Phone:918-847-2558
Mailing Address - Fax:918-847-2053
Practice Address - Street 1:112 NORTH 5TH STREET
Practice Address - Street 2:
Practice Address - City:BARNSDALL
Practice Address - State:OK
Practice Address - Zip Code:74002-0609
Practice Address - Country:US
Practice Address - Phone:918-847-2558
Practice Address - Fax:918-847-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKA100560Medicare Oscar/Certification
OK373824Medicare Oscar/Certification