Provider Demographics
NPI:1508226507
Name:ST JOHN HEALTH SYSTEM
Entity Type:Organization
Organization Name:ST JOHN HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIABETES EDUCATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD LD CDE
Authorized Official - Phone:918-744-2449
Mailing Address - Street 1:1717B S UTICA AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717B S UTICA AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5333
Practice Address - Country:US
Practice Address - Phone:918-744-2995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty