Basic Information
Provider Information
NPI: 1437543055
EntityType: 2
ReplacementNPI:  
OrganizationName: LESTER E COX MEDICAL CENTERS
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: COXHEALTH PRIMROSE OB-GYN
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 802843
Address2:  
City: KANSAS CITY
State: MO
PostalCode: 641802843
CountryCode: US
TelephoneNumber: 4177306430
FaxNumber: 4172697567
Practice Location
Address1: 1000 E PRIMROSE ST
Address2: SUITE 270
City: SPRINGFIELD
State: MO
PostalCode: 658075154
CountryCode: US
TelephoneNumber: 4178826900
FaxNumber: 4178828912
Other Information
ProviderEnumerationDate: 03/20/2015
LastUpdateDate: 08/26/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SHAMEL
AuthorizedOfficialFirstName: BROCK
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VICE PRESIDENT
AuthorizedOfficialTelephone: 4172694368
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/26/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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