Basic Information
| Provider Information | |||||||||
| NPI: | 1104829282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANTRELL | ||||||||
| FirstName: | SIDNEY | ||||||||
| MiddleName: | ALLEN RHEA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 CORONA RD | ||||||||
| Address2: | STE 102 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652032582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732341800 | ||||||||
| FaxNumber: | 5732341799 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 CORONA RD | ||||||||
| Address2: | STE 102 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652032582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732341800 | ||||||||
| FaxNumber: | 5732341799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R9D24 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 242095230 | 05 | MO | MEDICAID | 45797 | 01 | MO | FIRST HEALTH | OTHER | 710918160 | 01 | MO | BEECH STREET | OTHER | 10867027 | 01 | MO | BCBSKC PROVIDER | OTHER | 300200 | 01 | MO | FAMILY HEALTH PARTNERS | OTHER | 5824126001 | 01 | MO | CIGNA | OTHER | 710918160 | 01 | MO | UNITED HEALTHCARE | OTHER | 710918160 | 01 | MO | AETNA | OTHER | 1104829282 | 01 | MO | COMMUNITY HEALTH PLAN | OTHER | 268352 | 01 | MO | COVENTRY HEALTHCARE OF KC | OTHER | 710918160 | 01 | MO | GREAT WEST HEALTHPLANS | OTHER |