Basic Information
| Provider Information | |||||||||
| NPI: | 1255315289 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIGHTS | ||||||||
| FirstName: | THEODORE | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 E EVERGREEN ST | ||||||||
| Address2: | PO BOX 557 | ||||||||
| City: | CAMERON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 644292400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166322101 | ||||||||
| FaxNumber: | 8166493383 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 N DAVIS ST | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 646441143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165837839 | ||||||||
| FaxNumber: | 8165837842 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 12/02/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 106787 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 930021603 | 01 | MO | MEDICARE RAILROAD | OTHER | 7857433 | 01 | MO | MEDICARE PART B | OTHER | 206021008 | 05 | MO | MEDICAID |