Provider Demographics
NPI:1720096597
Name:SAINT JOHN HOSPITAL, INC
Entity Type:Organization
Organization Name:SAINT JOHN HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:913-680-6014
Mailing Address - Street 1:3500 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5043
Mailing Address - Country:US
Mailing Address - Phone:913-680-6000
Mailing Address - Fax:
Practice Address - Street 1:3500 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5043
Practice Address - Country:US
Practice Address - Phone:913-680-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH052002275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS519424OtherAETNA
MO90090017OtherBLUE CROSS OF KC
KS325940OtherFIRST GUARD
KS000021OtherBLUE CROSS KS
KS325940OtherFIRST GUARD
MO90090017OtherBLUE CROSS OF KC
KS519424OtherAETNA