Basic Information
| Provider Information | |||||||||
| NPI: | 1679067748 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LESTER E COX MEDICAL CENTERS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COXHEALTH URGENT CARE LEBANON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1423 N JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658021917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172693000 | ||||||||
| FaxNumber: | 4172693104 | ||||||||
| Practice Location | |||||||||
| Address1: | 1216 DEADRA DR | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 655364669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4177305650 | ||||||||
| FaxNumber: | 4177305655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2018 | ||||||||
| LastUpdateDate: | 03/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | MCWAY | ||||||||
| AuthorizedOfficialFirstName: | JACOB | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | EXEC. VICE-PRESIDENT & CFO | ||||||||
| AuthorizedOfficialTelephone: | 4172698811 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 500063011 | 05 | MO | MEDICAID |