Basic Information
| Provider Information | |||||||||
| NPI: | 1144256462 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LESTER E COX MEDICAL CENTERS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COXHEALTH CENTER AURORA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3800 S NATIONAL AVE | ||||||||
| Address2: | STE. 540 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658075209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172695712 | ||||||||
| FaxNumber: | 4172697567 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 COMMERCE DR | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656056260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172692400 | ||||||||
| FaxNumber: | 4172692410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 03/14/2017 | ||||||||
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| AuthorizedOfficialLastName: | BUETOW | ||||||||
| AuthorizedOfficialFirstName: | MAX | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. VICE-PRESIDENT & CFO | ||||||||
| AuthorizedOfficialTelephone: | 4176310381 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 505690800 | 05 | MO | MEDICAID | 189999 | 01 | BLUE CROSS | OTHER | 596053405 | 05 | MO | MEDICAID |