Basic Information
| Provider Information | |||||||||
| NPI: | 1699255299 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REGIONAL SERVICES | ||||||||
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| OtherOrganizationName: | COXHEALTH SCHOOL BASED TELEMEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4046 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658084046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172695712 | ||||||||
| FaxNumber: | 4172697567 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 E 9TH ST | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN GROVE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4179263177 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2018 | ||||||||
| LastUpdateDate: | 07/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUETOW | ||||||||
| AuthorizedOfficialFirstName: | MAX | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4176310381 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.