1780778449 NPI number — LESTER E COX MEDICAL CENTERS

Table of content: (NPI 1780778449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780778449 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:
COXHEALTH CENTER MT. VERNON
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:
1780778449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 S NATIONAL AVE
Provider Second Line Business Mailing Address:
#540
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65807-5284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-269-5712
Provider Business Mailing Address Fax Number:
417-269-4869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10763 HIGHWAY 39
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65712-7823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-269-2460
Provider Business Practice Location Address Fax Number:
417-269-2462
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
P
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
417-466-2875

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 116760 . This is a "BLUE CROSS OF MO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 508603909 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 598603900 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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