Provider Demographics
NPI:1841233913
Name:ST. JOHN'S INC.
Entity Type:Organization
Organization Name:ST. JOHN'S INC.
Other - Org Name:ST. JOHN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:BETHE;;
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-534-3085
Mailing Address - Street 1:104 E. 3RD ST
Mailing Address - Street 2:P.O. BOX 186
Mailing Address - City:ALDEN
Mailing Address - State:KS
Mailing Address - Zip Code:67512-0186
Mailing Address - Country:US
Mailing Address - Phone:620-534-3085
Mailing Address - Fax:620-534-3086
Practice Address - Street 1:208 MARC WAGNER RD
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:KS
Practice Address - Zip Code:67671
Practice Address - Country:US
Practice Address - Phone:785-735-2208
Practice Address - Fax:785-735-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty