1679520258 NPI number — MIDWEST DIVISION - LRHC LLC

Table of content: (NPI 1679520258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679520258 NPI number — MIDWEST DIVISION - LRHC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST DIVISION - LRHC LLC
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:
LAFAYETTE REGIONAL HEALTH CENTER
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:
1679520258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64067-1107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-259-2203
Provider Business Mailing Address Fax Number:
660-259-6819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64067-1107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-259-2203
Provider Business Practice Location Address Fax Number:
660-259-6819
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JAMES
Authorized Official First Name:
TERI
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
660-259-6893

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010568509 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90036022 . This is a "BLUE CROSS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 515720 . This is a "FIRST GUARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 757000 . This is a "FAMILY HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8316 . This is a "HEALTHCARE USA" identifier . This identifiers is of the category "OTHER".




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