1326084948 NPI number — LESTER E COX MEDICAL CENTERS

Table of content: (NPI 1326084948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326084948 NPI number — LESTER E COX MEDICAL CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LESTER E COX MEDICAL CENTERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OZARKS DIALYSIS SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326084948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1423 N JEFFERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65802-1917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-269-3000
Provider Business Mailing Address Fax Number:
417-269-3104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 E US HIGHWAY 60
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MONETT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65708-2668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-354-1111
Provider Business Practice Location Address Fax Number:
417-236-2666
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCWAY
Authorized Official First Name:
JACOB
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SR. VICE-PRESIDENT & CFO
Authorized Official Telephone Number:
417-269-8811

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 120907 . This is a "BCBS MO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 502989353 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com