Basic Information
Provider Information
NPI: 1528003746
EntityType: 2
ReplacementNPI:  
OrganizationName: LESTER E COX MEDICAL CENTERS
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: COX HEALTH CENTER ROGERSVILLE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3800 S NATIONAL AVE
Address2: #540
City: SPRINGFIELD
State: MO
PostalCode: 658075209
CountryCode: US
TelephoneNumber: 4172696262
FaxNumber: 4172694349
Practice Location
Address1: 151 JOHNSTOWN DR
Address2:  
City: ROGERSVILLE
State: MO
PostalCode: 657429366
CountryCode: US
TelephoneNumber: 4172692252
FaxNumber: 4172692259
Other Information
ProviderEnumerationDate: 06/19/2006
LastUpdateDate: 08/03/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: TAYLOR
AuthorizedOfficialFirstName: DAVID
AuthorizedOfficialMiddleName: P.
AuthorizedOfficialTitleorPosition: VICE PRESIDENT
AuthorizedOfficialTelephone: 4172696262
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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