1891154217 NPI number — LESTER E COX MEDICAL CENTERS

Table of content: (NPI 1891154217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891154217 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:
Provider Other Organization Name Type Code:
6
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:
1891154217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2240 W SUNSET ST STE 100
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:
65807-6041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-269-4663
Provider Business Mailing Address Fax Number:
417-269-0607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1447 STATE HIGHWAY 248
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BRANSON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65616-9656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-348-8300
Provider Business Practice Location Address Fax Number:
417-269-0607
Provider Enumeration Date:
02/12/2016

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: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 620036953 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0234260015 . This is a "MEDICARE NSC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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